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Purpose: To develop a novel external limiting membrane (ELM) and ellipsoid zone (EZ) restoration-based grading system after successful macular hole surgery (MHS) and to evaluate EZ as a structural biomarker for the final visual outcome. Methods: In a tertiary care center-based retrospective study, 34 consecutive cases of successful MHS for full-thickness macular holes (FTMHs) were included. Spectral domain optical coherence tomography (SD-OCT) cross-sectional analysis was performed on preoperative and postoperative data of weeks 1, 4, 12, and 24, respectively. Sequential measurements of FTMH size, ELM and EZ defect were performed using the caliper function of SD-OCT. MHS was uniquely graded as grade 0: persistence of ELM and EZ defect; grade 1: partial or complete restoration of ELM with shortening of EZ defect; and grade 2: complete restoration of ELM and EZ. Data were statistically analyzed on Statistical Package for the Social Sciences software-version 24. Results: MHS was graded as grade 0 (n = 8), grade 1 (n = 15), and grade 2 (n = 11). Best corrected visual activity (BCVA) was found to be 1.13 ± 0.19 in grade 0, 0.59 ± 0.09 in grade 1, and 0.26 ± 0.06 in grade 2. One-way analysis of variance showed improvement in final BCVA among the three grades (P < 0.001) Postoperative visual acuity and residual EZ defect had a statistically significant linear correlation (r = 0.899, P < 0.001). EZ was found to be an excellent structural biomarker for final BCVA (area under the curve = 0.99). Conclusion: Successful MHS is associated with better visual outcomes in eyes with restored EZ. ELM restoration preceded EZ regeneration. MHS novel grading system is physician friendly, incorporates pathoanatomic aspects, and correlates well with visual outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Small full-thickness macular holes (FTMHs) are classically treated surgically but can also occasionally close spontaneously. Long-term visual outcomes of spontaneously closed FTMHs are not well described. We compared best-corrected visual acuity (BCVA) after surgical and spontaneous closure of idiopathic FTMH (IMHs) and assessed the effect of IMH size on BCVA. Methods: This retrospective study was performed at Rothschild Foundation Hospital, Paris, France, from January 2015 to June 2021. The study included patients with small IMH, i.e., ≤250 μm, divided into spontaneously closed IMH (SIMH) and surgically closed IMH. Both groups were divided into 3 subgroups according to IMH diameter: <100 μm, 100–150 μm, or 151–200 μm. Results: A total of 109 patients had surgical IMH closure and 18 spontaneous IMH closure. Among all the patients of the study, we observed 17% of spontaneous closure. All SIMHs were <250 μm. The groups did not differ in final BCVA or BCVA gain. BCVA significantly improved after surgery whatever the IMH size. In the SIMH group, final BCVA did not differ by IMH size. In the 100–150 μm subgroups, BCVA gain was significantly greater for the surgical closure compared to the SIMH groups (−0.35 ± 0.2 vs. −0.16 ± 0.2 logMAR; p = 0.01). Conclusion: Vision results are similar between spontaneously closed and surgically closed macular holes. Spontaneous closure of macular holes can occur; it is therefore reasonable to consider observation before macular hole surgery. [ABSTRACT FROM AUTHOR]

The surgical management of macular holes is undergoing continuous evolution, with recent focus on the utilization of platelet concentrates as a promising adjunctive intervention. Currently, they present a valid surgical approach for achieving anatomical and functional success with a non-inferiority comparably to the alternative surgical techniques. Nonetheless, the utilization of varied platelet concentrates terminologies, coupled with the lack of standardization in their preparation methodologies, engenders both lexical confusion and challenges in comparing scientific studies published up until now. In this review, we summarized the published evidence concerning the application of platelet concentrates in macular holes surgery, aiming to clarify the terminology and methodologies employed and to establish a common consensus facilitating further development and diffusion of this promising technique. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the ganglion cell-inner plexiform layer (GCIPL), ganglion cell complex (GCC) change determined by spectral domain optical coherence tomography (OCT) in cases undergone surgical treatment for idiopathic macular hole (MH), examine the anatomical indices of the hole structure measured by OCT and correlate between best corrected visual acuity (BCVA). Materials and Methods: Preoperative, postoperative month-1 and month-3 data of 25 eyes of 25 patients, who underwent surgery for idiopathic stage 3 and 4 MH, were retrospectively analyzed. Factors whose effects on BCVA were investigated are age, gender, GCIPL, GCC, hole base diameter, minimum linear dimension, hole height, Macular hole index (MHI), Diameter Hole index, Tractional hole index (THI) and ellipsoid zone (EZ) recovery was determined. The GCIPL and GCC changes of the patients after surgery were compared with the values of the age and sex matched healthy control group in addition to the fellow eyes' measurements. Results: The patient group consisted of 25 subjects, 32% (n=8) of whom were men and 68% (n=17) of whom were women. The mean age of the patients was 63.8 ± 6.7 (years). The average age of the control group was calculated as 61 ± 8.8 (years) which consisted of 10 males (40%) and 15 females (60%). Preoperative mean of BCVA was 0.91±0.29 logMAR. Post-operative month-1 and month-3 mean of BCVA were 0.74±0.30 logMAR and 0.49±0.26 logMAR respectively (p<0.05). The postoperative 3rd month GCIPL and GCC values of the cases showed a significant decrease compared to the preoperative measurements (p<0.05). There was a statistically significant linear correlation between postoperative 3rd month BCVA and GCC inferior and temporal values (r=-0.560; r=-0.585 and p=0.004; p= 0.002, respectively). A significant positive linear association was found between the postoperative month-3 BCVA,logMAR, the minimum linear diameter and base diameter (r=0.478; r=0.419 and p=0.016; p= 0.037, respectively). EZ defect was strongly associated with postoperative month-3 BCVA and changes in visual acuity (p=0.0001, r= 0.711 and p=0.0001, r= 0.690, respectively). The value of MHI=0.419 could predict good visual prognosis. Conclusions: Preoperative hole geometry could be used to predict surgical prognosis. In the GCIPL and GCC analysis, the inferior and temporal values are associated with the final visual outcome. Visual acuity decreases as the ellipsoid zone loss increases. MHI=0.419 may be predictive for good visual prognosis. [ABSTRACT FROM AUTHOR]

A 62-year-old man with a 30-year-old photographically documented idiopathic full-thickness macular hole and visual acuity of 6/45 developed an acute macula-on rhegmatogenous retinal detachment in his left eye. A pars plana vitrectomy, internal limiting membrane peeling around the macular hole, fluid-air exchange, endolaser retinopexy around the peripheral retinal break and perfluoropropane (C3F8) internal tamponade were performed to repair the detached retina and macular hole. One month postoperatively, the patient developed a large peripheral circumferential retinal tear with shallow retinal detachment which necessitated scleral buckling, repeat vitrectomy, endolaser photocoagulation and C3F8 tamponade. The retina was successfully re-attached and the macula hole was closed. Three years post-vitrectomy, the repaired 30-year-old macular hole remained closed although the visual acuity remained unchanged at 6/45. In summary, we describe the successful anatomical closure of a 30-year-old idiopathic full-thickness macular hole which we believe to be the longest duration photographically documented macular hole closed following surgery. [ABSTRACT FROM AUTHOR]

Background: In this study, our objective is to investigate the predictive factors influencing the anatomical and functional success of macular hole surgery in the Kashmir population. By analyzing a cohort of patients who underwent macular hole surgery, we aim to explore the preoperative characteristics, surgical techniques employed, and postoperative outcomes that contribute to the success rates in this specific population. Methods: This retrospective observational study was conducted at the Department of Ophthalmology, GMC Srinagar over a period of one year. A total of 70 patients, ranging in age from 45 to 76 years, were included in the analysis. We reviewed their preoperative characteristics, surgical techniques utilized, and postoperative outcomes. Results: Our findings revealed a prominent age group between 51-60 years, comprising 44.3% of the sample, followed by individuals aged 61-70 years, accounting for 31.4% of the cohort. Notably, female patients exhibited a higher representation, constituting 61.4% of the total sample. The duration of symptoms varied widely, ranging from 1 to 15 months, with the majority of patients (67.1%) reporting symptom duration of 1-6 months. Anatomically, Type 1 closure predominated, with an overwhelming majority of cases at 85.7%. Significantly, despite the absence of notable age and gender differences between the Type 1 and Type 2 closures, substantial variations were observed in critical parameters such as hole height, hole form factor (HFF), macular hole index (MHI), tractional hole index (THI), and postoperative best-corrected visual acuity (BCVA) between the two closure types. Conclusion: Our study highlights the utmost importance of a comprehensive evaluation that takes into account age, gender, and anatomical characteristics when assessing macular hole patients. These findings provide crucial insights for refining treatment strategies and tailoring interventions to optimize surgical outcomes in this specific population. [ABSTRACT FROM AUTHOR]

This case report describes a novel surgical technique for the treatment of macular hole and focal macular detachment associated with high myopia and posterior staphyloma. A 65-year-old female presented with a stage 3C myopic traction maculopathy and VA of 20/600. OCT examination confirmed a macular hole of 958 μm diameter, posterior staphyloma, and macular detachment. We performed combined phacoemulsification surgery with 23G pars plana vitrectomy; the anterior capsule was preserved and divided into two equal circular laminar flaps. We proceeded with central and peripheral vitrectomy, brilliant blue staining, and partial ILM peeling; capsular sheets were introduced sequentially in the vitreous chamber, the first one was implanted below the hole and attached to pigment epithelium, the second lamina was inserted into the hole, and the remaining portion of ILM was implanted crosswise below the edges of the hole. Macular-hole closure and progressive reapplication of the macular detachment were obtained, with a final VA of 20/80. Treatment of macular holes and focal macular detachment in high myopic eyes is complex, even for experienced surgeons. We propose a new technique with additional mechanisms based on anterior lens capsule and internal limiting membrane tissue properties that showed functional and anatomical improvement and could be considered an alternative treatment.

In this paper, we compare the post-operative macular microvascular parameters (vascular density and foveal avascular zone) in eyes with refractory macular hole (MH) that underwent pars plana vitrectomy and autologous retinal transplant (ART) with the fellow unoperated eye. We conducted a retrospective case control study of six consecutive patients who underwent pars plana vitrectomy and ART with at least six months of post-operative follow-up. Pre-operatively, all eyes underwent SD-OCT (Spectral Domain Optical Coherence Tomography) examination. Post-operative OCT-A analyses included vascular density (VD) and the foveal avascular zone (FAZ) area. Six patients with a mean age of 63.7 ± 14.3 years were included. The mean follow-up was 24 months (range 6–30 months). The pre-operative BCVA (best-corrected visual acuity) was 0.99 ± 0.46 logMAR and 1.02 ± 0.23 logMAR at the last post-operative visit (p = 1.00). The mean MH diameter was 966 ± 620 µm. VD in the MH group was 28.1 ± 7.3% compared to 20.2 ± 2.9% in the fellow eyes group (p < 0.05). The mean post-operative FAZ area in the MH group was 109.8 ± 114.6 mm2 compared to 41.5 ± 10.4 mm2 in the control group (p < 0.05). In all six eyes, MH closure was obtained. The post-operative visual acuity did not improve after ART. Eyes with a closed MH showed a bigger FAZ with a higher VD compared to the fellow healthy eye. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the anatomical and functional macular results and rate of complications following surgical treatment of primary macular hole (MH) with autologous platelet rich plasma (a-PRP) use., Design: retrospective, interventional, non-randomized case series., Partecipants and Methods: A cohort of 9 consecutive patients from January 1, 2019 to August 31, 2021 who underwent vitrectomy with a-PRP use for primary MH were included. Anatomical results based on spectral domain- optical coherence tomography (SD-OCT) and visual acuity were analyzed., Results: 10 pseudophakic eye of 9 patients were enrolled. Six patients were female and three patients were male. The mean age was 69.9 years ± 1.48. The baseline MH minimum diameter was 486.1 μm ± 37.1, and mean pre operative best-corrected visual acuity (BCVA) was 0.91 ± 0.03 logMAR (Snellen equivalent 20/160). Mean 1 month post operative BCVA was 0.81 ± 0.57 logMAR (Snellen equivalent 20/130; p  = 1.000); mean 3 month post operative BCVA was 0.66 ± 0.04 logMAR (Snellen equivalent 20/90; p  = 0.006); mean 6 month post operative BCVA was 0.6 ± 0.04 logMAR (Snellen equivalent 20/80; p  < 0.001). In all eyes, 10/10 (100%), there was a complete MH closure at 6 months follow up: 5 eyes (50%) with a U-type closure pattern, 4 eyes (40%) with a V-type pattern and 1 eye (10%) with an irregular foveal contour closure at 6 month follow-up. No ocular and systemic complications were reported., Conclusion: The a-PRP use is a successful and promising vitreoretinal surgical technique option for primary MH., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The aim of this study was to evaluate the use of PRGF (plasma rich in growth factors) as an adjuvant to PPV (pars plana vitrectomy) in recurrent, persistent, or poor prognosis MH (macular hole). Patients with MH were treated with PPV plus adjuvant therapy (PRGF membrane (mPRGF) and injectable liquid PRGF (iPRGF)). The anatomical closure of MH and postoperative BCVA (best-corrected visual acuity) were evaluated. Eight eyes (eight patients) were evaluated: myopic MH (MMH, n = 4), idiopathic MH (IMH, n = 2), iatrogenic n = 1, traumatic n = 1. The mean age was 53.1 ± 19.3 years. Hence, 66.7% (n = 4) of patients previously had internal limiting membrane peeling. Five patients (62.5%) received mPRGF and iPRGF, and three patients (37.5%) received iPRGF. Gas tamponade (C3F8) was placed in seven cases and one case of silicone oil. Anatomic closure of MH was achieved in seven eyes (87.5%) and BCVA improved in six cases. In the MMH group, visual acuity improved in two lines of vision. Follow-up time was 27.2 ± 9.0 months. No adverse events or MH recurrences were recorded during follow-up. The use of PRGF as an adjuvant therapy to PPV can be useful to improve anatomical closure and visual acuity in MH surgery.

This case report describes a novel surgical technique for the treatment of macular hole and focal macular detachment associated with high myopia and posterior staphyloma. A 65-year-old female presented with a stage 3C myopic traction maculopathy and VA of 20/600. OCT examination confirmed a macular hole of 958 μm diameter, posterior staphyloma, and macular detachment. We performed combined phacoemulsification surgery with 23G pars plana vitrectomy; the anterior capsule was preserved and divided into two equal circular laminar flaps. We proceeded with central and peripheral vitrectomy, brilliant blue staining, and partial ILM peeling; capsular sheets were introduced sequentially in the vitreous chamber, the first one was implanted below the hole and attached to pigment epithelium, the second lamina was inserted into the hole, and the remaining portion of ILM was implanted crosswise below the edges of the hole. Macular-hole closure and progressive reapplication of the macular detachment were obtained, with a final VA of 20/80. Treatment of macular holes and focal macular detachment in high myopic eyes is complex, even for experienced surgeons. We propose a new technique with additional mechanisms based on anterior lens capsule and internal limiting membrane tissue properties that showed functional and anatomical improvement and could be considered an alternative treatment. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study aimed to evaluate the prognostic factors associated with the success of fluid–gas exchange in patients who had undergone failed primary idiopathic macular hole (IMH) surgery. Methods: In total, 19 eyes of 19 patients with failed IMH surgery who then underwent fluid–gas exchange were included. Of those, 18 eyes had macular hole (MH) closure (successful, 15 eyes; unsuccessful, 3 eyes). Demographics, pre-operative characteristics, and pre-procedural characteristics were assessed. The patients were divided into successful (U or V-type closure) and unsuccessful groups (W-type or unclosed), following fluid–gas exchange. One eye was unclosed after fluid–gas exchange; therefore, this patient underwent additional vitrectomy for MH closure (unsuccessful). Results: The outcomes of the fluid–gas exchange were categorized as unclosed or as U-type, V-type, or W-type closure. None of the patients experienced complications after the procedure. The successful group showed a significantly lower pre-operative and pre-procedural minimum diameter, base diameter, and macular hole volume, and higher pre-operative and pre-procedural macular hole index, hole form factor, and tractional hole index values. Moreover, a better visual prognosis was observed in the successful group. Conclusion: These findings suggest that indices predicting favorable results of primary surgery for IMH are useful for predicting the success of fluid–gas exchange in patients with failed primary MH surgery. [ABSTRACT FROM AUTHOR]

Sol Lee, Ron P Gallemore Retina Macula Institute, Torrance, CA, 90503, USACorrespondence: Ron P Gallemore 4201 Torrance Blvd, Suite 220, Torrance, CA, 90503, USATel +1 310 413-7020Email rongallemoremd@gmail.comPurpose: To present a successful case of macular hole surgery in a patient with dome-shaped maculopathy (DSM).Observations: Patient with DSM had successful closure of a full-thickness macular hole with surgery. There was persistent subretinal fluid after the surgery, which showed some response to a combination of a diuretic and a nonsteroidal anti-inflammatory drug (NSAID).Conclusions and Importance: Full-thickness macular hole in DSM may be effectively managed with modern surgical techniques.Keywords: macular hole surgery, dome-shaped maculopathy, serous retinal detachment, spironolactone, NSAID

The aim of this manuscript is to describe a novel retinal finding of Alport syndrome during surgical management of an associated macular hole. A retrospective chart review of a 65-year-old man with a diagnosis of Alport syndrome confirmed by renal biopsy was found to have an associated full-thickness macular hole. Pars-plana vitrectomy surgery with internal limiting membrane (ILM) peeling was attempted, but intraoperatively the ILM was found to be absent at the macula. Alport syndrome may be associated with the absence of the ILM. This can complicate attempts at macular hole repair.

Purpose: We aimed to report the impact of the COVID-19 pandemic and related health policies and restrictions on the provision and efficacy of macular hole (MH) surgery. Methods: We carried out a retrospective cohort study. Two MH patient cohorts, those treated during the COVID-19 pandemic (12 months) and the pre-COVID-19 period (12 months before the lockdown) were reviewed and compared. Patient characteristics, time to consultation and surgery, MH size, baseline and postoperative visual acuity (VA) and failure rate were recorded and analysed. Results: A reduction of 43% in MH surgery occurred during the COVID-19 period (93 eyes vs. 53 eyes). Mean time to consultation and time to surgery increased significantly (52.7 days vs. 86.3 days, p < 0.01 and 51.3 days vs. 83.6 days, p = 0.01, respectively), while mean baseline and postoperative vision was significantly lower in the COVID-19 group (0.75 LogMAR vs. 0.63 LogMAR, p < 0.01 and 0.61 LogMAR vs. 0.44 LogMAR, p < 0.01, respectively). The median MH size was significantly larger in the COVID-19 group (296 μm vs. 365 μm, p = 0.016), and the failure rate increased from 7.6% to 15.4% (odds ratio 2.2 (95% CI: 0.72–6.8)). Conclusions: Our findings suggest the COVID-19 pandemic caused a significant reduction in MH surgery, increased waiting times and led to poorer surgical outcomes. For future pandemics, better strategies are required that allow semi-elective and elective surgery to continue in a timely fashion. Health providers should preserve the delivery of ophthalmological care, with enhanced encouragement to seek medical help for acute symptoms. [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.)

The purpose of this case report is to describe a chandelier-assisted bimanual autologous retinal transplantation (ART) with air tamponade technique for the treatment of a large macular hole (MH). A patient with a primary chronic large MH, who underwent chandelier-assisted bimanual ART with the use of air tamponade is described. The MH diameter was 888 μm. Changes in best-corrected visual acuity (BCVA) were measured postoperatively; clinical pictures and optical coherence tomography were analyzed. Baseline preoperative BCVA was 20/400. Closure of the MH was achieved. At 7 months, post-surgery BCVA improved to 20/50. Optical coherence tomography examinations showed the integration of the autologous transplant with the adjacent macular tissue and continuity preservation of the ellipsoid layer. In conclusion, chandelier-assisted bimanual ART with air tamponade technique was effective in achieving complete MH closure and long-term visual improvement.

OBJECTIVE: Herein, we introduce the infusion direction manipulation technique and the infusion off technique. These relatively simple methods control intra-vitreal fluid flow direction and turbulence and release negative pressure in the microforceps to facilitate handling of the internal limiting membrane. The aim of this study is to introduce an effective and uncomplicated method to handle the internal limiting membrane (ILM) during the temporal inverted ILM flap and free ILM flap techniques in macular hole surgery by controlling the direction and status of the infusion. MATERIALS AND METHODS: The direction of the infusion flow was controlled with a free finger (usually the 4th finger) during the inverted ILM flap surgery to stabilize the flap location during the fluid-air exchange. A valved trocar was used, and the infusion was discontinued during the free ILM flap surgery. Turbulence was minimized, and negative pressure around the head-shaft junction of the microforceps was released. RESULTS: The ILM flap remained stable in all patients who underwent macular hole surgery with our technique. CONCLUSIONS: Infusion direction manipulation technique and infusion off technique are efficient and simple methods to handle the ILM during ILM surgery. [ABSTRACT FROM AUTHOR]

Copyright of Balikesir Health Sciences Journal / Balıkesir Sağlık Bilimleri Dergisi is the property of Balikesir Health Sciences Journal (BAUN Health Sci J) 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.)

The aim of this study was to evaluate the use of PRGF (plasma rich in growth factors) as an adjuvant to PPV (pars plana vitrectomy) in recurrent, persistent, or poor prognosis MH (macular hole). Patients with MH were treated with PPV plus adjuvant therapy (PRGF membrane (mPRGF) and injectable liquid PRGF (iPRGF)). The anatomical closure of MH and postoperative BCVA (best-corrected visual acuity) were evaluated. Eight eyes (eight patients) were evaluated: myopic MH (MMH, n = 4), idiopathic MH (IMH, n = 2), iatrogenic n = 1, traumatic n = 1. The mean age was 53.1 ± 19.3 years. Hence, 66.7% (n = 4) of patients previously had internal limiting membrane peeling. Five patients (62.5%) received mPRGF and iPRGF, and three patients (37.5%) received iPRGF. Gas tamponade (C3F8) was placed in seven cases and one case of silicone oil. Anatomic closure of MH was achieved in seven eyes (87.5%) and BCVA improved in six cases. In the MMH group, visual acuity improved in two lines of vision. Follow-up time was 27.2 ± 9.0 months. No adverse events or MH recurrences were recorded during follow-up. The use of PRGF as an adjuvant therapy to PPV can be useful to improve anatomical closure and visual acuity in MH surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Many factors can influence the functional outcomes of macular hole surgery and some studies have tried to describe anatomical features that could predict successful treatment. The purpose of this study is to describe a new technique for evaluating the healing of macular holes after two surgical techniques using a black-and-white pixel binarization histogram software by optical coherence tomography angiography and its potential functional implications. Methods This was a retrospective, observational case series of patients who presented with idiopathic full-thickness macular holes and underwent vitreoretinal surgery for successful macular hole closure using the internal limiting membrane peeling technique or the inverted peeling technique or the free internal limiting membrane flap technique. Optical coherence tomography angiography 3.0 × 3.0-mm scans were obtained postoperatively. The outer retina layer was analyzed separately; three different analyses were performed within a 3.0-mm-diameter area central circle, a 1.5-mm-diameter area, and a 0.5-mm-diameter area from the foveal center. The outer retinal layer images were evaluated by counting the number of black and white pixels. The inclusion criteria were patients with idiopathic macular holes who underwent ophthalmologic examinations and swept-source optical coherence tomography 1 week and 1 and 6 months postoperatively. The exclusion criteria were a traumatic macular hole or a history of eye trauma and a diagnosis of glaucoma or any other chronic ocular disease. The Mann–Whitney test was used to determine significance; P

Purpose: This study aims to analyze the success rate and functional outcome after revision surgery of persistent idiopathic full-thickness macular holes in a large patient cohort and to identify the optimal tamponade strategy and the value of new adjunctive manipulation techniques for persistent macular hole (pMH) closure. Methods: Retrospective, comparative, non-consecutive case series of all revisional surgeries for idiopathic pMH between 2011 and 2019 at the Eye Clinic Sulzbach were identified. Of 1163 idiopathic MH surgeries, 74 eyes of 74 patients had pMH. Of those, group 1 (n = 38) had vitrectomy with tamponade alone (20% sulfur hexafluoride gas, 15% hexafluoroethane gas, silicone oil 5000, Densiron®), while group 2 (n = 36) included tamponade with adjuvant manipulation (internal limiting membrane (ILM) translocation, subretinal fluid injection, epiretinal amniotic membrane, free retina graft, or autologous blood). Main statistical outcomes were anatomic closure rate, visual acuity (VA), minimum linear diameter (MLD), and base diameter (BD). Results: Overall total anatomical success rate was 81.1% and mean VA improved 3.5 lines from LogMAR 1.03 ± 0.30 to 0.68 ± 0.38 (p <.001). Preoperative MLD or BD had no effect on total anatomic success (p = 0.074, p = 0.134, respectively). When comparing the two groups, slightly better anatomic success rates were achieved in group 1 (84.2%) compared to that in group 2 (77.8%) (p = 0.68). Final VA in group 1 (LogMAR 0.67 ± 0.39) outperformed group 2 (LogMAR 0.86 ± 0.38) (p = 0.03). Conclusions: Revisional surgery for persistent idiopathic MH with tamponade alone had comparable anatomical closure but better VA outcomes, compared to tamponade with adjuvant manipulation. [ABSTRACT FROM AUTHOR]

The aim of this manuscript is to describe a novel retinal finding of Alport syndrome during surgical management of an associated macular hole. A retrospective chart review of a 65-year-old man with a diagnosis of Alport syndrome confirmed by renal biopsy was found to have an associated full-thickness macular hole. Pars-plana vitrectomy surgery with internal limiting membrane (ILM) peeling was attempted, but intraoperatively the ILM was found to be absent at the macula. Alport syndrome may be associated with the absence of the ILM. This can complicate attempts at macular hole repair. [ABSTRACT FROM AUTHOR]

Purpose: To assess the incidence of normal vision following anatomically successful macular hole surgery and associated clinical variables. Methods: Multicentre, retrospective chart review. Preoperative, intraoperative and postoperative clinical data were extracted from electronic medical records from seven European vitreoretinal units. Inclusion criteria were as follows: eyes undergoing primary vitrectomy for idiopathic full‐thickness macular hole from January 2015 to January 2018; postoperative macular hole closure confirmed by spectral domain optical coherence tomography (OCT); preoperative pseudophakia or phakic eyes receiving combined cataract surgery; one‐year follow‐up. The primary outcome was 'normal vision' defined as a final best‐corrected visual acuity (BCVA) ≥ 20/25. Univariate, multivariate and decision‐tree analyses were conducted to evaluate the clinical variables associated with 'normal vision'. Odds ratios (OR) and confidence intervals (CIs) were calculated. Results: Of 327 eligible cases, 91 (27.8%) achieved 'normal vision' at 1 year. Multivariate analysis identified variables significantly associated with 'normal vision': shorter symptom duration (odds ratio [OR]=1.05; 95% confidence interval [CI]:1.02‐1.09; p = 0.002), smaller preoperative OCT minimum linear diameter (OR per 100‐micron increase = 1.65; 95%CI:1.31‐2.08; p < 0.001) and better mean preoperative BCVA (OR = 15.13; 95%CI: 3.59‐63.65; p < 0.001). The decision‐tree analysis found that the most significant variable associated with 'normal vision' was symptom duration. 'Normal vision' was achieved in 70.6% of eyes operated within one week from symptom onset and in 45% of eyes with symptom duration between 1 and 3 weeks. Conclusions: These findings suggested urgent surgery is justified for small macular holes of short duration. [ABSTRACT FROM AUTHOR]

Purpose: To describe the successful closure of an idiopathic macular hole (MH) with topical therapy after surgery failed. Methods: A case report was evaluated and prospective literature review performed. Results: After surgery to correct an MH in a 57-year-old female patient failed, topical therapy was initiated. MH closure was successful using this modality. Conclusions: There are few reports in the literature describing successful closure of an idiopathic full-thickness MH with topical therapy after initial surgery fails. This reinforces the importance of the "hydration" hole in this disease. Characterization with optical coherence tomography may help determine which patients could benefit from topical treatment for MH closure and avoid costly and invasive surgical procedures., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of the article., (© The Author(s) 2024.)

The purpose of this case report is to describe a chandelier-assisted bimanual autologous retinal transplantation (ART) with air tamponade technique for the treatment of a large macular hole (MH). A patient with a primary chronic large MH, who underwent chandelier-assisted bimanual ART with the use of air tamponade is described. The MH diameter was 888 μm. Changes in best-corrected visual acuity (BCVA) were measured postoperatively; clinical pictures and optical coherence tomography were analyzed. Baseline preoperative BCVA was 20/400. Closure of the MH was achieved. At 7 months, post-surgery BCVA improved to 20/50. Optical coherence tomography examinations showed the integration of the autologous transplant with the adjacent macular tissue and continuity preservation of the ellipsoid layer. In conclusion, chandelier-assisted bimanual ART with air tamponade technique was effective in achieving complete MH closure and long-term visual improvement. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the long-term functional and anatomical outcomes of combined phacovitrectomy and sequential vitrectomy and cataract surgery for macular hole (MH) and cataract. Methods: This retrospective comparative study analyzed the medical records of 58 patients who underwent phaco vitrectomy (n=24) or sequential surgery (n=34) for MH and cataract between March 2014 and March 2016. Patients were divided into the combined surgery group, which underwent combined surgery for MH and cataract extraction, and the sequential surgery group, which underwent vitrectomy first, followed by cataract extraction. The primary outcome measures were the best-corrected visual acuity (BCVA) before surgery and at 3, 6, 12, and 24 months after surgery and successful hole closure. Results: A total of 58 patients were included in this study. The change in BCVA at 3 months after surgery was significantly better in the combined surgery group than in the sequential surgery group. However, no significant difference was found between the groups at 6, 12, and 24 months after surgery. Cataract surgery was performed at 4.9±1.2 months after the first surgery (vitrectomy) in the sequential surgery group. In the success group, the rates of hole closure were 95.8% (23/24) and 97% (33/34) in the combined and sequential surgery groups, respectively. Conclusion: Combined phaco vitrectomy and sequential vitrectomy and cataract surgery are safe and effective methods for treatment of MH and cataract. Although both methods demonstrate similar anatomical and functional success, combined surgery appears superior over sequential surgery because of the early visual improvement, decreased patient morbidity, and lower cost. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical presentation, morphological features and surgical outcomes of macular hole (MH) secondary to retinal vein occlusion (RVO). Method: This prospective interventional study evaluated eight eyes with atypical MH (secondary to RVO) and data regarding medical management, pars plana vitrectomy, postoperative anatomical hole closure, visual acuity improvement, morphological features of hole were noted till the last follow-up. Results: Eight eyes with full-thickness MH in an RVO eye were followed-up for a minimum period of 3 months postoperatively. Five subjects had a RVO episode which occurred more than 6 months before the onset of the recent symptoms (Group 1; 4 branch RVO and 1 central RVO), and 3 subjects had a recent onset branch RVO within 6 months (Group 2). All FTMH cases except one showed closure at the last follow-up. Visual acuity of all eyes improved from 0.91 ± 0.57 logMAR to 0.5 ± 0.3 logMAR (p = 0.093). At baseline, visual acuities of the two groups had no significant difference. Postoperatively, group 1 holes had better visual prognosis, than Group 2 holes, further substantiated by persistence of subretinal fluid in Group 2 eyes till last follow-up. Minimum hole diameter was higher in the recent RVO group, although anatomical closure was obtained in all of these eyes. Most holes had favorable morphological hole features like raised configuration with rounded edges. Conclusion: In the presence of favorable morphological features, secondary macular holes associated with retinal vein occlusion may show optimal outcomes after surgery. It is not clear whether acutely created holes in recent onset RVO should be operated early. Older holes may have better prognosis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the correlations between anatomical and functional changes in idiopathic macular hole (IMH) surgery in long-term follow-up. Methods: This is a prospective, interventional single centre case series. The final sample is formed by 14 eyes of 14 patients who had undergone IMH surgery in our institution between 2005 and 2009 and were still followed up in 2019. Reported data were pre- and post-operative best-corrected visual acuity (BCVA), retinal sensitivity and fixation stability values on MP-1 and structural macular features on spectral domain optical coherence tomography. Optical coherence tomography angiography (OCTA) was utilized to assess microvascular characteristics at the final visit. Only patients with a successful MH closure were enrolled, excluding eyes affected by other relevant pathologies. Results: Mean BCVA improvement was significant after surgery (t test, p value < 0.001) and presented a slight, not statistically significant raise, between the post-operative and long-term follow-up. Differently, mean retinal sensibility (dB) showed a highly statistically significant difference between pre-operative and post-operative (t test, p value =.002) and post-operative and last follow-up (p value < 0.001). In the long-term follow-up, subjects having integrity of the inner segment/outer segment (IS/OS) layer showed no statistically significant difference in BCVA compared with subjects with IS/OS discontinuity (t test, p value = 0.72). OCTA parameters of the operated eye showed no statistical significance compared with the fellow eye. Conclusions: In successfully closed MHs, retinal sensibility measured by microperimetry significatively increases after a long follow-up period even when BCVA remains stable or raises slightly. Vessel density organization tends to be quantitatively similar to fellow eye several years after surgery. [ABSTRACT FROM AUTHOR]

Purpose: To summarize current surgical techniques for treating primary macular holes (MHs). Methods: We reviewed publications detailing surgical approaches to primary MHs, briefly described their protocols, and outlined their results. Results: Currently, the technique for primary MH repair is pars plana vitrectomy, removing the posterior cortical vitreous, stripping the epiretinal membranes, and ending with intraocular gas tamponade. The evident benefit of peeling off the internal limiting membrane (ILM) was clearly shown for MHs at stages 2 to 4 by achieving an anatomical closure rate of > 90%, even in large MH up to 650 μm. Newer MH surgical techniques include modification of ILM flap techniques, placing an autologous scaffolding of tissue within the hole, and cell therapy has shown to increase the closure rate of large and chronic macular holes, resulting in modest functional improvement in complicated MHs. Conclusion: Since the turn of the century, the success rate of modern macular surgery has increased, even for large and chronic MHs. There seems to be no limit to novel concepts in MH surgery, which range from anatomical closure to those proposing natural restoration of visual function via stem cell therapy. [ABSTRACT FROM AUTHOR]

Background: Many factors can influence the functional outcomes of macular hole surgery and some studies have tried to describe anatomical features that could predict successful treatment. The purpose of this study is to describe a new technique for evaluating the healing of macular holes after two surgical techniques using a black-and-white pixel binarization histogram software by optical coherence tomography angiography and its potential functional implications. Methods: This was a retrospective, observational case series of patients who presented with idiopathic full-thickness macular holes and underwent vitreoretinal surgery for successful macular hole closure using the internal limiting membrane peeling technique or the inverted peeling technique or the free internal limiting membrane flap technique. Optical coherence tomography angiography 3.0 × 3.0-mm scans were obtained postoperatively. The outer retina layer was analyzed separately; three different analyses were performed within a 3.0-mm-diameter area central circle, a 1.5-mm-diameter area, and a 0.5-mm-diameter area from the foveal center. The outer retinal layer images were evaluated by counting the number of black and white pixels. The inclusion criteria were patients with idiopathic macular holes who underwent ophthalmologic examinations and swept-source optical coherence tomography 1 week and 1 and 6 months postoperatively. The exclusion criteria were a traumatic macular hole or a history of eye trauma and a diagnosis of glaucoma or any other chronic ocular disease. The Mann–Whitney test was used to determine significance; P < 0.05 was considered significant. Results: Ten eyes of 10 patients who underwent vitreoretinal surgery to treat a macular hole either with the conventional peeling technique (n = 5) or the inverted/free internal limiting membrane flap technique (n = 5) were included. In the peeling group, the percentage of white pixels ranged from 7.22% to 18.40% in the 0.5 × 0.5-millimeter area in the macular center; the mean postoperative logarithm of the minimum angle of resolution best-corrected visual acuity was 0.3 ± 0.2. In the inverted flap group, the percentage of white pixels ranged from 3.65% to 8.93% in the 0.5 × 0.5-millimeter area in the macular center; the mean logarithm of the minimum angle of resolution best-corrected visual acuity was 0.9 ± 0.4. Conclusions: A simple method of optical coherence tomography angiography imaging analysis of the outer retina using a binarization technique of the black and white pixels was created and may have functional implications during the analysis of the healing process after macular hole surgery. We hypothesized that higher numbers of white pixels correspond to viable cellularity and better prognoses postoperatively. [ABSTRACT FROM AUTHOR]

Many ocular diseases are associated with an alteration of the mechanical and the material properties of the eye. These mechanically-related diseases include macular hole and pucker, two ocular conditions due to the presence of abnormal physical tractions acting on the retina. A complete relief of these tractions can be obtained through a challenging microsurgical procedure, which requires the mechanical peeling of the internal limiting membrane of the retina (ILM). In this paper, we provide the first comparative study of the nanoscale morphological and mechanical properties of the ILM in macular hole and macular pucker. Our nanoscale elastic measurements unveil a different bio-mechanical response of the ILM in the two pathologies, which correlates well to significant differences occurring during microsurgery. The results here presented pave the way to the development of novel dedicated microsurgical protocols based on the material ILM properties in macular hole or pucker. Moreover, they contribute to clarify why, despite a common aetiology, a patient might develop one disease or the other, an issue which is still debated in literature. [ABSTRACT FROM AUTHOR]

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Purpose: Various profibrotic and proinflammatory cytokines have been found upregulated in uncomplicated primary retinal detachment (pRD), but without providing a uniform picture. Here, we compare the cyto- and chemokine profiles in pRD with and without proliferative vitreoretinopathy (PVR) in an attempt to unravel relevant differences not in single cytokines, but in the cytokine profiles at diagnosis. Methods: Undiluted vitreous fluid (VF) was obtained at the beginning of surgery from 174 eyes with pRD without relevant PVR (maximally grade B; group 1; n = 81) and with moderate or advanced PVR requiring a gas tamponade (group 2; n = 49) or silicon oil filling (group 3; n = 44). VF of eyes undergoing macular hole (MH) surgery served as controls (group 4; n = 26). Forty-three cytokines were quantified in parallel using a multiplex cytokine analysis system (Bioplex). For all comparisons we applied Holm’s correction to control for multiple comparisons. Results: 44.9% of group 2 eyes presented grade C1 and 55.1% C2-C3, whereas 86.4% of group 3 eyes exhibited a PVR grade of C2-D. CCL19 was the only cytokine that displayed higher concentrations in the vitreous of eyes with PVR C1 compared to lower PVR grades. Eyes with PVR C2-D showed higher levels of CCL27, CXCL6, IL4, IL16, CXCL10, CCL8, CCL22, MIG/CXCL9, CCL15, CCL19, CCL 23 and CXCL12 compared to controls. Interestingly, no difference of cytokine levels was detected between C1 and C2-D PVR. Conclusions: CCL19 may represent a potential biomarker for early PVR progression that holds promise for future diagnostic and therapeutic applications. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of idiopathic full-thickness macular hole in a young boy, which was managed surgically with good visual and anatomical outcomes. Method: Single case report. Results: An 8-year-old boy presented for defective vision in the left eye noticed for the past 2 weeks with best-corrected visual acuity of 6/24. A large full-thickness macular hole was diagnosed clinically and was confirmed on optical coherence tomography. There was no clinical or tomographic findings suggestive of trauma or retinal degeneration. After observation for 8 weeks, the patient underwent macular hole surgery in the left eye including internal limiting membrane peeling and C3F8 gas tamponade. Intraoperatively abnormally tight vitreoretinal adherence was noted during the induction of posterior vitreous detachment. Optical coherence tomography at 1 month after surgery showed decrease in the size of macular hole suggestive of incomplete closure. Repeat optical coherence tomography at 3 months showed closed macular hole with mild foveal thinning and ellipsoid zone discontinuity with best-corrected visual acuity improving to 6/18. The tomographic features and best-corrected visual acuity remained stable at 6-month followup. Conclusion: We hereby report the first case, to the best of our knowledge, of a truly idiopathic full-thickness macular hole in an 8-year-old boy. Surgical treatment offers the best outcomes in these cases and should be considered at the earliest without waiting for spontaneous closure unlike in the case of traumatic full-thickness macular hole. [ABSTRACT FROM AUTHOR]

Purpose: The internal limiting membrane (ILM) is a normal part of the retina, and the outcomes of ILM removal have not been fully investigated. ILM flap inversion is a recently developed technique that increases the success rate of macular hole (MH) surgery. Thus, we compared the anatomical closure rate and visual outcome in patients undergoing microincision vitrectomy surgery (MIVS) with ILM flap inversion or conventional ILM peeling for the treatment of MH. Methods: The medical records of 90 eyes with MH were reviewed retrospectively. The patients were classified into two groups based on MIVS procedure (group 1: ILM flap inversion, 46 eyes; group 2: ILM peeling, 44 eyes). Results: Preoperative characteristics were similar in the two groups, and there were no significant differences in 1 month- or 6 month-postoperative VA between the groups (P = 0.25 and P = 0.42, respectively). However, the surgical success rate was significantly higher in group 1 than group 2 (P = 0.04; 46/46: 100% and 41/44: 93%, respectively). Multiple regression analysis revealed that axial length and MH diameter were independent factors predicting 6-month postoperative BCVA in group 2 (P = 0.001 and P = 0.03, respectively), and that MH diameter was an independent factor predicting 6-month postoperative VA in group 1 (P = 0.03). Logistic regression analysis revealed that axial length (OR = 2.11; P = 0.02; area under the curve: 0.94; cut off score: 28.4 mm) was an independent factor indicating surgical failure in group 2. Conclusion: Our results suggest that MIVS with ILM flap inversion might be best suited to treat MH, particularly in patients with high myopia. [ABSTRACT FROM AUTHOR]

Purpose: Ocriplasmin injection may close some small-to-medium macular holes associated with vitreoretinal traction. If the treatment fails, does vitrectomy and gas injection yield the same results as primary surgery? Material and Methods: We report a retrospective case series study of 3 eyes of 3 consecutive patients operated on a few months after initial intravitreal injection of ocriplasmin and enlargement of the macular hole. The minimal follow-up period after surgery was 18 months. Results: Surgery was uneventful in all cases. Vitrectomy, internal limiting membrane peeling, and gas injection allowed closing of the 3 macular holes with a progressive improvement in visual acuity over time. Before ocriplasmin injection, visual acuity ranged from 20/60 to 20/32, after failed ocriplasmin injection from 20/80 to 20/40, and at the final follow-up after 18 months from 20/32 to 20/25. Conclusion: Vitrectomy with internal limiting membrane peeling leads to closure of macular holes even in cases of prior failure to close them by ocriplasmin injection. [ABSTRACT FROM AUTHOR]

The present study was performed to establish a novel ocular surgery simulator for training in peeling of the inner limited membrane (ILM). This simulator included a next-generation artificial ILM with mechanical properties similar to the natural ILM that could be peeled underwater in the same manner as in actual surgery. An artificial eye consisting of a fundus and eyeball parts was fabricated. The artificial eye was installed in the eye surgery simulator. The fundus part was mounted in the eyeball, which consisted of an artificial sclera, retina, and ILM. To measure the thickness of the fabricated ILM on the artificial retina, we calculated the distance of the step height as the thickness of the artificial ILM. Two experienced ophthalmologists then assessed the fabricated ILM by sensory evaluation. The minimum thickness of the artificial ILM was 1.9 ± 0.3 μm (n = 3). We were able to perform the peeling task with the ILM in water. Based on the sensory evaluation, an ILM with a minimum thickness and 1000 degrees of polymerization was suitable for training. We installed the eye model on an ocular surgery simulator, which allowed for the performance of a sequence of operations similar to ILM peeling. In conclusion, we developed a novel ocular surgery simulator for ILM peeling. The artificial ILM was peeled underwater in the same manner as in an actual operation. [ABSTRACT FROM AUTHOR]