To report anatomic and visual improvement after pars plana vitrectomy with gas tamponade for a lamellar macular hole with poor central visual acuity.
Two interventional case reports.
Two patients with a lamellar macular hole underwent vitrectomy, internal limiting membrane peeling, and long-acting gas injection. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and optical coherence tomography findings.
Vitrectomy with gas tamponade resulted in biomicroscopic, functional, and tomographic improvement in both patients for follow-up periods of 12 months.
Vitrectomy with gas tamponade may be an effective method for a lamellar macular hole with poor visual acuity.
"Indications for surgical treatment of LMH remain controversial. A limited number of reports on vitrectomy results in LMH patients have been published, and most studies reported favorable outcomes.45,52–54 Recent reports on vitrectomy with removal of the ERM-ILM with or without gas injection demonstrated benefit both functionally and morphologically.55,56 "
[Show abstract][Hide abstract] ABSTRACT: Optical coherence tomography (OCT) is now a standard of care in ophthalmology and is considered essential for the diagnosis and monitoring of many retinal diseases. One of the major advances obtained with OCT was the understanding of the pathophysiology of macular holes. Non-full-thickness macular holes have been revisited because high-resolution OCT images can detect a lamellar macular defect that is not always visible clinically, and surgery has been advocated by some authors. OCT can be valuable in determining the need for and/or timing of surgical intervention on epiretinal membranes or vitreomacular traction syndrome. In addition, we can use this technology as a predictive factor in the prognosis and follow-up of the most common posterior pole pathologies.
"Theodossiadis et al. studied 41 patients with LMH and reported a mean decline of 6.4% in visual acuity (VA) after 37.1 months of observation (Theodossiadis et al. 2009). Only a limited number of reports on vitrectomy results in LMH patients have been published and most studies reported favourable outcomes (Hirakawa et al. 2005; Witkin et al. 2006, 2010; Kokame & Tokuhara 2007; Garretson et al. 2008; Androudi et al. 2009; Michalewska et al. 2010; Casparis & Bovey 2011; Figueroa et al. 2011). However, whether it is worthwhile to attempt a surgical treatment for LMH remains a controversial issue. "
[Show abstract][Hide abstract] ABSTRACT: Purpose: To evaluate the association between the macular structure on spectral-domain optical coherence tomography (SD-CT) and visual outcome after vitrectomy for lamellar macular hole (LMH).
Methods: Best-corrected visual acuity (VA) and SD-OCT images of the macula were assessed before and after surgery in 30 eyes of 30 patients with a LMH. Preoperative VA and SD-OCT features were investigated as predictors of surgical outcome.
Results: Mean patient age was 65 years with female predominance (77%). Visual acuity improved in 19 eyes (63%) with an overall mean improvement of 1 Snellen line (from 20/65 to 20/50; p = 0.002) at a mean of 18 months after vitrectomy. Subgroup analysis showed that statistically significant visual benefit was only observed in patients with an intact photoreceptor inner segment/outer segment (IS/OS) junction (p = 0.003), with foveal thickness bigger than 100 μm (p = 0.004) and with initial VA better than 20/100 (p = 0.003). The most efficient model to predict final VA was the combination of preoperative VA and the presence or absence of IS/OS disruption (r2 = 0.77, p < 0.001).
Conclusions: Poor initial VA, the presence of a disrupted IS/OS junction or a thin fovea on preoperative SD-OCT predicted poor vision outcome after LMH surgery.
[Show abstract][Hide abstract] ABSTRACT: Optical coherence tomography (OCT) is a valuable tool for assessment of the vitreoretinal interface. This article reviews the normal process of age-related posterior vitreous detachment as viewed by OCT. Abnormalities of the vitreoretinal interface as imaged by OCT are described including vitreomacular traction syndrome, cystoid macular edema/ diabetic macular edema, epiretinal membranes, full thickness macular holes, lamellar holes, pseudoholes, microholes, and schisis from myopia or optic pits/colobomas. This tool has given us new insights into the pathogenesis of these retinal abnormalities.
Survey of Ophthalmology 07/2007; 52(4):397-421. DOI:10.1016/j.survophthal.2007.04.007 · 3.85 Impact Factor
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