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Spectral versus Time-Domain OCT in Detecting Preoperative Epiretinal Membranes that Accompany Macular Holes
摘要： Purpose: To compare the sensitivities of spectral-domain optical coherence tomography (SD-OCT) versus time-domain OCT (TD-OCT) in identifying epiretinal membranes (ERM) preoperatively in patients who underwent surgery for full-thickness macular holes (FTMH). Methods: This is an interventional retrospective case series of 59 eyes diagnosed with FTMHs who underwent 25-G pars plana vitrectomy with internal limiting membrane peeling between 2009 and 2015. Preoperative OCTs were obtained by SD-OCT (Spectralis, Heidelberg, Germany) or TD-OCT (Stratus, Carl Zeiss Meditec, Dublin, CA, USA). Volume scans were reviewed for ERM accompanying the FTMH. This was compared to indocyanine green-negative staining and intraoperative findings of ERM as the gold standard. Results: Baseline characteristics between the SD-OCT and TD-OCT groups were comparable. Mean duration of postoperative follow-up was 41.4 weeks (±49.0). Of 59 eyes, 33 (55.9%) exhibited an ERM intraoperatively. Four ERMs (SD-OCT group) compared to 12 (TD-OCT group) were not visualized on preoperative OCT (p = 0.003). Sensitivity and specificity of SD-OCT in ERM detection was 79% and 100% compared to 14% and 91% for TD-OCT. Visual acuity improved in both arms (0.5 and 0.3 logMAR units in SD-OCT and TD-OCT, respectively (p = 0.002, 0.0002). Conclusions: We found that SD-OCT was superior to TD-OCT in identifying the presence of ERM preoperatively in patients who underwent macular hole surgery. Since ERMs may decrease the chance of successful pharmacologic vitreolysis, we recommend using SD-OCT over TD-OCT in the evaluation of patients with FTMH to more accurately identify ERMs and allow more comprehensive treatment decisions (pharmacologic versus surgical).
关键词： Epiretinal membrane,Spectral-domain optical coherence tomography,Macular hole,Time-domain optical coherence tomography
更新于2025-09-23 15:22:29
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Prevalence of vitreomacular adhesion: an optical coherence tomography analysis in the retina clinic setting
摘要： Purpose: The aims of this study were to determine the prevalence of vitreomacular adhesion (VMA) in a random sample of clinical patients at three US retina clinics and to assess comorbid retinal conditions, ocular diseases, prior treatment history, and other medical histories. Patients and methods: This observational, retrospective cohort study was based on patients from the Doheny Eye Centers, Duke Eye Center, and Tufts Medical Center who received a bilateral spectral domain optical coherence tomography (SD-OCT) scan (one scan/eye) for clinical evaluation with available medical records. The study had three phases: 1) collection of retrospective patient data; 2) review of OCT scans at a reading center to assess VMA and associated conditions; and 3) analyses and reporting of data on the prevalence of VMA, patient demographics, and comorbid conditions. Data were obtained from electronic health records and OCT grading forms. Outcome measures from bilateral SD-OCT scans and medical records included OCT evaluation of VMA and retinal comorbid conditions. Results: In 719 patients with 1,483 reviewable OCT scans, the prevalence of VMA was estimated at 14.74% (90% CI, 12.58%–16.92%). The prevalence of unilateral VMA was estimated at 12.39%, while bilateral VMA was 2.36%. In patients with VMA, 34 out of 123 eyes with VMA (27.64%) also had fovea deformed by vitreomacular traction. Macular hole (MH) was significantly more prevalent in VMA-diagnosed eyes versus non-VMA-diagnosed eyes (6.5% versus 1.9%; P=0.02). There was a significantly higher incidence of full-thickness MH (P=0.008), operculum/flaps (P<0.0001), and lamellar or pseudo-holes (P=0.048) in VMA-diagnosed versus non-VMA-diagnosed eyes. Age, MH as a comorbid condition, full-thickness MH, lamellar or pseudo-holes, and operculum were predictive of a VMA diagnosis. Conclusion: The prevalence of VMA was estimated at 14.74% in a random sample of patients from three retina clinics. VMA diagnosis can be predicted by factors, including age, MH as a comorbid condition, and lamellar or pseudo-holes.
关键词： VMA,macular hole,vitreomacular traction,lamellar or pseudo-holes,operculum/flaps,comorbid conditions,OCT
更新于2025-09-23 15:22:29
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EFFECT OF LASER PHOTOCOAGULATION ON MACULAR EDEMA ASSOCIATED WITH MACULAR HOLES
摘要： To report the outcomes of laser therapy to barricade eccentric full-thickness macular hole with associated cystoid macular edema. We report two patients who developed an eccentric full-thickness macular hole with persistent cystoid macular edema after pars plan vitrectomy with and without internal limiting membrane peel for epiretinal membrane and the results of argon laser therapy. Barricade argon laser therapy was applied concentric to the full-thickness macular hole. Associated cystoid macular edema was noted to resolve within 1 to 3 months of therapy in both cases. Barricade laser therapy surrounding a macular hole can lead to resolution of associated cystoid macular edema. Pathogenic mechanisms to explain this favorable outcome are discussed.
关键词： cystoid macular edema,argon laser,epiretinal membrane,PPV/ILM,laser retinopexy,laser barricade,eccentric macular hole,macular hole
更新于2025-09-12 10:27:22
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Vitreomacular interface alterations following peripheral laser retinopexy: Interface changes after laser
摘要： Aim: To demonstrate the morphological outcomes of macular hole following prophylactic peripheral laser retinopexy (PPLR). Methods: Our retrospective case-control analysis included 92 eyes, 55 in the laser group and 37 in the non-laser group. Fifty-five patients were subjected to prophylactic peripheral laser retinopexy in preparation for pars plana vitrectomy for macular hole, with and without vitreomacular adhesion (laser group). Before and after prophylactic peripheral laser retinopexy, we evaluated any changes in vitreomacular anatomy by optical coherence tomography. Optical coherence tomography changes were also analyzed in the visits preceding pars plana vitrectomy in 37 macular hole eyes not subjected to prophylactic peripheral laser retinopexy (non-laser group). Results: In the laser group, 7 out of 55 eyes (12.7%) showed macular hole closure (6 out of 18 macular hole eyes with vitreomacular adhesion (33.3%) and 1 out of 37 eyes without vitreomacular adhesion (2.7%)), while no patients showed macular hole closure in the non-laser group (p < 0.05). The mean width of the seven closed macular hole was 191.4 μm (range: 59–282 μm). In all except one of the six macular hole eyes with vitreomacular adhesion, the macular hole closed without vitreomacular adhesion release. In our analysis of the patient subgroup with vitreomacular adhesion, we observed a release of vitreomacular adhesion in 3 out of 18 eyes (16.6%) in the laser group and in 1 out of 13 eyes (7.6%) in the non-laser group (p > 0.05). Conclusion: These findings support a possible beneficial role for prophylactic peripheral laser retinopexy in selected individuals with macular hole.
关键词： Laser retinopexy,macular hole,macular hole closure,vitreomacular adhesion
更新于2025-09-12 10:27:22
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Validation of sensor for postoperative positioning with intraocular gas
摘要： Purpose: Surgical repair of retinal attachment or macular hole frequently requires intraocular gas. This necessitates specific postoperative positioning to improve outcomes and avoid complications. However, patients struggle with correct positioning. We have developed a novel sensor to detect the position of the gas bubble in the eye and provide feedback to patients in real time. In this paper, we determine the specificity and sensitivity of our sensor in vitro using a model eye. Methods: We assessed the reliability of our sensor to detect when a gas bubble has deviated off a model retinal break in a model eye. Various bubble sizes representing the intraocular kinetics of sulfur hexafluoride gas and varying degrees of deviation from the correct position were tested using the sensor attached to a mannequin head with a model eye. Results: We recorded 36 data points. The sensor acted appropriately in 33 (91.7%) of them. The sensor triggered the alarm every time the bubble deviated off the break (n=15, sensitivity =100%). However, it triggered the alarm (falsely) 3/21 times when the bubble was correctly positioned over the retinal break (specificity =86%). Conclusion: Our device shows excellent sensitivity (100%) and specificity (86%) in detecting whether intraocular gas is tamponading a retinal break in a model eye.
关键词： vitrectomy,retinal detachment,intraocular gas,postoperative positioning,macular hole,pneumatic retinopexy
更新于2025-09-09 09:28:46
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Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique
摘要： Purpose The aim of this study was to determine the effect of the inverted internal limiting membrane (ILM) flap technique on the macular hole (MH) closure and foveal microstructure recovery of patients with highly myopic MH. Methods Pars plana vitrectomy and gas tamponade with the inverted ILM flap technique (19 eyes) or with the ILM peeling technique (21 eyes) were performed in patients with highly myopic MH with or without retinal detachment. The rate of MH closure and retinal reattachment, the reconstructive anatomical change of the foveal microstructure and the best-corrected visual acuities (BCVA) of the two groups were compared. results The anatomic closure rate was statistically significantly higher in the inverted group (100%) than in the peeling group (66.7%; p=0.009). All eyes with MH retinal detachment had successful retinal reattachment in these two groups. However, the rate of the external limiting membrane (ELM) and ellipsoid zone (EZ) (p=0.020), as well as gliosis (p=0.049) in macular area, detected by OCT, was significantly greater in the inverted group than in the peeling group. The postoperative BCVA was significantly better in the eyes with ELM, EZ (p=0.031) and gliosis (p=0.008), but without hyperreflective foci (p=0.001). Conclusions These findings demonstrate that the inverted ILM flap technique has better efficacy than the ILM peeling technique for patients with myopic MH in closure rate, foveal microstructure and postoperative BCVA.
关键词： foveal microstructure,myopic macular hole,ILM peeling technique,visual outcomes,inverted internal limiting membrane flap technique
更新于2025-09-09 09:28:46
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The Evaluation of Prognostic Factors after Vitrectomy for Lamellar Macular Hole Using Optical Coherence Tomography
摘要： Purpose: To evaluate the prognostic factors that predict visual outcome after vitrectomy for lamellar macular hole using optical coherence tomography (OCT). Methods: This study included 26 eyes that underwent pars plana vitrectomy, epiretinal membrane removal, and internal limiting membrane peeling for lamellar macular hole. The maximum parafoveal thickness, maximum height and diameter of lamellar macular hole, maximum height and diameter of intraretinal splitting, thinnest foveal floor thickness, and inner segment/outer segment disruption length on preoperative OCT image were investigated for prognostic factors that predict visual outcome. Results: The mean follow-up period was 32.2 months and the mean best corrected visual acuity improved significantly after vitrectomy from log MAR 0.47 ± 0.32 to log MAR 0.23 ± 0.23. The postoperative visual acuity correlated significantly with preoperative visual acuity, thinnest foveal floor thickness and inner segment/outer segment disruption length, but not with maximum parafoveal thickness, maximum height and diameter of lamellar macular hole and maximum height and diameter of intraretinal splitting. Conclusions: The thinnest foveal floor thickness and inner segment/outer segment disruption length on preoperative OCT image were significant prognostic factors.
关键词： Lamellar macular hole,Optical coherence tomography,Prognostic factors
更新于2025-09-04 15:30:14
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Role of Tractional Forces and Internal Limiting Membrane in Macular Hole Formation: Insights from Intraoperative Optical Coherence Tomography
摘要： We report the case of a 69-year-old patient who underwent vitrectomy for vitreomacular traction (VMT) and developed a postoperative macular hole that was observed 1 week after surgery. The hole did not close by in-office fluid-gas exchange alone, but was achieved after repeat surgery with internal limiting membrane (ILM) peeling. Intraoperative OCT (iOCT) images from the first surgery revealed an occult macular hole that formed after VMT release. We discuss how iOCT findings provide insight into the role of the ILM in macular hole formation and emphasize the importance of carefully inspecting iOCT images in real time to avoid missing small but important findings.
关键词： Macular hole,Optical coherence tomography,Internal limiting membrane,Vitreomacular traction
更新于2025-09-04 15:30:14
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Optical Coherence Tomography Imaging After Surgical Closure of Pediatric Traumatic Macular Holes
摘要： Purpose: To date, little attention has been directed to retinal photoreceptor migration after traumatic macular hole surgical repair in the pediatric population. The purpose of this study was to evaluate optical coherence tomography (OCT) findings in the foveae of pediatric patients with history of traumatic macular hole surgical repair. Methods: Retrospective case series of 3 eyes in 3 pediatric patients with traumatic macular hole surgical repair. Spectral domain OCT images were obtained pre- and post-operatively. Results: We report 3 cases of restoration of the ellipsoid zone with good visual acuity outcomes following macular hole closure. Conclusion: Optical coherence tomography findings of an intact ellipsoid zone may be a predictor of visual acuity and explain better surgical outcomes in the pediatric population.
关键词： pediatric,trauma,macular hole
更新于2025-09-04 15:30:14