Effect of macular hole volume on postoperative central macular thickness / O efeito do volume de buraco macular da espessura macular central pós-operatória

ABSTRACT Purpose: To evaluate the association between macular hole volume (MHV) and postoperative central macular thickness (CMT) using spectral-domain optical coherence tomography (SD-OCT). Methods: Thirty-three eyes of 30 patients with a large full-thickness idiopathic macular hole with or without vitreomacular traction who underwent surgical intervention were included in this cross-sectional study. Complete ophthalmological examination, including SD-OCT, was performed for all participants during the pre- and postoperative visits. MHV was preoperatively measured using SD-OCT, which captured the widest cross-sectional image of the hole. For normal distribution analysis of the data, the Kolmogorov-Smirnov test was performed, and for statistical analyses, chi-square, Student's t-test, Mann-Whitney U test, and Pearson's correlation coefficient test were performed. Results: Mean preoperative best-corrected visual acuity (BCVA) and MHV were found to be 0.99 ± 0.36 (range, 0.3-2.0) logMAR and 0.139 ± 0.076 (range, 0.004-0.318) mm3, respectively. Mean follow-up was 16.3 ± 14.3 (range, 3-50) months. No statistical correlations were found between MHV and postoperative BCVA (p=0.588) and between MHV and disease recurrence (p=0.544). A weak negative correlation existed between MHV and final CMT scores (p=0.04, r=-0.383). Conclusions: Greater MHV was found to be weakly associated with lower postoperative CMT scores.

RESUMO Objetivo: Avaliar a relação entre o volume do buraco macular (MHV) e a espessura macular central pós-operatória (CMT) por meio da tomografia de coerência óptica de domínio espectral (SD-OCT). Método: Trinta e três olhos de 30 pacientes com buracos maculares idiopáticos de espessura total grandes, com ou sem tração vitreorretiniana, que foram submetidos a intervenção cirúrgica foram incluídos neste estudo transversal. O exame oftalmológico completo, incluindo SD-OCT foi realizado nas visitas pré e pós-operatórias de todos os participantes. MHV foi medido a partir da imagem de SD-OCT pré-operatória que capturou a imagem mais larga da secção transversal do buraco. Após a análise distribuição nomral da população do estudo ter sido realizada com o teste Kolmogorov-Smirnov, os testes de qui-quadrado, t de Student, Mann-Whitney U e teste de correlação de Pearson foram utilizados para as estatísticas. Resultados: As médias pré-operatórias da melhor acuidade visual corrigida (BCVA) e MHV foram 0,99 ± 0,36 logMAR (variação de 0,3-2,0) e 0,139 ± 0,076 mm3 (variação de 0,004-0,318). O seguimento médio foi de 16,3 ± 14,3 meses (variação de 3-50). Não foram encontradas correlações estatísticas entre MHV e BCVA pós-operatória (p=0,588), bem como MHV e recorrência da doença (p=0,544). Uma fraca correlação negativa estava presente entre MHV e pontuações finais CMT (p=0,04, r=-0,383). Conclusões: Maior MHV foi fracamente relacionado com CMT mais baixo, no pós-operatório.

Fechamento espontâneo de buraco de mácula em olhos previamente vitrectomizados: relato de dois casos / Spontaneous closure of macular hole after pars plana vitrectomy: report of two cases

O fechamento espontâneo de buraco de mácula de espessura total é um fenômeno raro, especialmente em olhos vitrectomizados. Descrevemos nesse relato dois casos com essa apresentação. No primeiro caso, notou-se o buraco de mácula 1 mês após vitrectomia por membrana epirretiniana e, no segundo, 3 semanas após vitrectomia por descolamento de retina regmatogênico. O fechamento desses buracos ocorreu espontaneamente 2 meses e 1 mês após sua documentação, respectivamente. Feita a revisão bibliográfica e propostas teorias para explicar esta evolução atípica, o entendimento deste fenômeno pôde nos ajudar a refinar a indicação cirúrgica desta patologia.

The spontaneous closure of a full-thickness macular hole (MH) developed after vitrectomy is very uncommon. We report a small series of cases (two patients) with this presentation. The first patient developed a MH 1 month after vitrectomy for an epirrretinal membrane and, the second one, 3 weeks after vitrectomy for rhegmatogenous retinal detachment. The MHs resolved spontaneously 2 months and 1 month after their documentation by optical coherence tomography(OCT), respectively. In this case report, we review the literature on spontaneous closure of MHs and discuss possible mechanisms for this rare event.

Macular hole: 10 and 20-MHz ultrasound and spectral-domain optical coherence tomography / Buraco macular: ultrassonografia de 10 e 20 MHz e tomografia óptica de domínio espectral

PURPOSE: Optical coherence tomography (OCT) is valuable for macula evaluation. However, as this technique relies on light energy it cannot be performed in the presence of opaque media. In such cases, the ultrasound (US) may predict some macular features. The aim of this study was to characterize images obtained by ultrasound with 10 and 20-MHz transducers comparing to OCT, as well as to analyze the relationship between the vitreous and retina in eyes with macular hole (MH). METHODS: 29 eyes of 22 patients with biomicroscopic evidence of MH at different stages were included. All patients were evaluated using ultrasonography with 10 and 20-MHz transducers and OCT. RESULTS: OCT identified signs of MH in 25 of 29 eyes. The remaining 4 cases not identified by US were pseudoholes caused by epiretinal membranes. In MH stages I (2 eyes) and II (1 eye), both transducers were not useful to analyze the macular thickening, but suggestive findings as macular irregularity, operculum or partial posterior vitreous detachment (PVD) were highlighted. In stages III (14 eyes) and IV (5 eyes), both transducers identified the double hump irregularity and thickening. US could measure the macular thickness and other suggestive findings for MH: operculum, vitreomacular traction and partial or complete PVD. In cases of pseudoholes, US identified irregularities macular contour and a discrete depression. CONCLUSION: 10-MHz US was useful for an overall assessment of the vitreous body as well as its relationship to the retina. The 20-MHz transducer allowed valuable information on the vitreomacular interface and macular contour. OCT provides superior quality for fine morphological study of macular area, except in cases of opaque media. In these cases, and even if OCT is not available, the combined US study is able to provide a valid evaluation of the macular area improving therapeutic approach.

OBJETIVO: A tomografia de coerência óptica (OCT) é um método diagnóstico valioso para estudo da mácula. Entretanto, por se basear na energia luminosa, não pode ser realizada quando existe opacidade de meios. Nesses casos, o ultrassom (US) pode predizer algumas características maculares. Este estudo teve como objetivos caracterizar imagens obtidas por US com transdutores de 10 e 20-MHz comparadas ao OCT, assim como analisar a relação vitreorretiniana em olhos com buraco macular (BM). MÉTODOS: Vinte e nove olhos de 22 pacientes com evidência biomicroscópica de BM em diferentes estágios foram incluídos. Todos os pacientes foram avaliados com ultrassonografia utilizando transdutores de 10 e 20-MHz e OCT de domínio espectral. RESULTADOS: OCT diagnosticou BM em 25 dentre 29 olhos estudados. Os 4 casos não identificados por US eram pseudoburacos decorrentes de membrana epirretiniana. Nos BM estágios I (2 olhos) e II (1 olho), ambos transdutores não foram úteis para analisar o espessamento macular, mas foram identificados sinais sugestivos como irregularidade macular, opérculo ou descolamento parcial do vítreo posterior (DVP). Nos estágios III (14 olhos) e IV (5 olhos), ambos transdutores identificaram irregularidade, dupla corcova e espessamento macular. O US foi capaz de medir a espessura macular e identificar outros indícios de BM, como opérculo, tração vitreorretiniana e DVP. Em pseudoburacos, o US identificou irregularidades no contorno macular e discreta depressão. CONCLUSÃO: US de 10-MHz foi útil para uma avaliação global do corpo vítreo e sua relação à retina. O US de 20-MHz forneceu informações importantes sobre a junção vitreorretiniana e contorno macular. OCT fornece qualidade superior para estudo morfológico da região macular, exceto em casos de opacidade de meios. Nesses casos, ou quando o exame tomográfico não for disponível, o estudo ultrassonográfico de 10 e 20-MHz é capaz de proporcionar análise válida da região macular e auxiliar na abordagem terapêutica.

Bilateral macular holes in X-linked retinoschisis: Now the spectrum is wider.

Bilateral occurrence of macular hole in X-linked retinoschisis is an extremely rare event. Spectral domain optical coherence tomography (OCT) findings revealed that formation of a macular hole is secondary to the retinoschisis process alone. Bilateral macular holes should be added to the spectrum of X-linked retinoschisis variations and the retinoschisis process alone should be accounted for their formation.

Central Photoreceptor Viability and Prediction of Visual Outcome in Patients with Idiopathic Macular Holes

PURPOSE: To identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs). METHODS: Data from 55 eyes with idiopathic MHs which had been sealed by vitrectomy were retrospectively reviewed. Correlation analysis was conducted between postoperative visual acuity (V(postop), logarithm of the minimum angle of resolution [logMAR]) and preoperative factors, including four OCT parameters: the anticipated length (A) devoid of photoreceptors after hole closure, MH height (B), MH size (C), and the grading (D) of the viability of detached photoreceptors. Additionally, the formula for the prediction of visual outcome was deduced. RESULTS: V(postop) was determined to be significantly correlated with the preoperative visual acuity (V(preop)) and OCT parameters A, C, and D (p<0.001). Based on the correlation, the formula for the prediction of V(postop) was derived from the most accurate regression analysis: V(postop)=0.248xV(preop)+1.1x10(-6)xA(2)-0.121xD+0.19. CONCLUSIONS: The length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.

Roturas retinianas em retinocoroidite por toxoplasmose: série de casos / Retinal tears in toxoplasmic retinochoroiditis: case series

Trata-se de série retrospectiva de 10 pacientes com rotura retiniana e retinocoroidite por toxoplasmose atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, de janeiro de 2007 a abril de 2008, com objetivo de avaliar a relação entre lesões de retinocoroidite e a ocorrência de rotura retiniana. Foram utilizados teste de Fisher e qui-quadrado com nível de significância p<0,05. Oito casos (80 por cento) apresentaram descolamento de retina. Doze roturas foram identificadas, localizando-se principalmente na periferia temporal superior (6 casos, 50 por cento). Não foi observada relação estatisticamente significativa entre localização da rotura e da cicatriz coriorretiniana considerando a distribuição em cinco quadrantes (p=0,0828) ou em três zonas (p=0,2507). A ocorrência de roturas retinianas em pacientes com uveíte posterior pode estar relacionada ao descolamento precoce do vítreo posterior causado pelo processo inflamatório intraocular. Não foi observado neste estudo correlação entre a localização das roturas retinianas e as cicatrizes de coriorretinite, o que sugere um mecanismo não relacionado diretamente à cicatriz.

This study is a retrospective case series aiming to evaluate the relation between toxoplasmic retinochoroiditis scars and the occurrence of retinal tears. Ten patients with retinal tear and toxoplasmic retinochoroiditis examined at the School of Medicine of Ribeirão Preto Clinics Hospital, between January 2007 and April 2008, were included. Fisher test and qui-square test with significance level of p<0.05 were used. Eight cases (80 percent) had retinal detachment. Twelve tears were found and localized mostly in the temporal superior periphery (6 cases, 50 percent). No statistically significant association between retinal tear and chorioretinal scar localization was observed considering five retinal quadrants (p=0.0828) or three zones (p=0.2507). The occurrence of retinal tears in patients with uveitis may be related to early posterior vitreous detachment caused by the intraocular inflammatory process. No correlation was observed between the localization of retinal tears and chorioretinal scars in this study, which suggests a causative factor not directly related to the presence of a scar.

Aspectos clínicos e tomográficos dos microburacos maculares / Clinical and tomographic aspects of macular microholes

OBJETIVO: Descrever os aspectos clínicos e tomográficos do microburaco macular. MÉTODOS: Estudaram-se pacientes portadores de microburaco macular de forma retrospectiva e observacional. Apurou-se história clínica, medida de acuidade visual, biomicroscopia de polo posterior, retinografia, angiofluoresceinografia retiniana e tomografia de coerência óptica. RESULTADOS: Examinaram-se oito olhos de sete pacientes portadores de microburaco macular. A idade variou entre 26 e 63 anos (média de 48,8 anos). Seis pacientes eram do sexo feminino (85,7 por cento). Cinco pacientes apresentaram o microburaco macular no olho direito (62,5 por cento). Quanto à sintomatologia, cinco indivíduos referiram diminuição da acuidade visual (71,4 por cento), um referiu escotoma central (14,3 por cento) e um não apresentou queixas visuais (14,3 por cento). A angiofluoresceinografia retiniana não mostrou alterações maculares em cinco dos olhos (71,4 por cento). À tomografia de coerência óptica, os oito olhos apresentaram uma lesão foveal hiporrefletiva e menor do que 100 micra, que acometia as camadas mais profundas da retina neurossensorial. CONCLUSÃO: Microburaco macular é um pequeno defeito lamelar presente na camada externa profunda da retina, que é evidente à biomicroscopia macular como uma lesão arredondada avermelhada de tamanho diminuto, levando a pouca repercussão na função visual, sem caráter progressivo. A história clínica, a acuidade visual, a biomicroscopia de fundo e a tomografia de coerência óptica são os principais elementos para a detecção e o estudo dos mecanismos fisiopatológicos responsáveis pela sua origem e evolução.

PURPOSE: To describe the clinical aspects and evaluate optical coherence tomography of macular microholes. METHODS: Seven patients were assessed (8 eyes) with microholes of the macula. All patients underwent complete eye examination, fundus photography, fluorescent angiography and OCT-3 imaging. RESULTS: Ages ranged from 26 to 69 years. Six patients were female (85.7 percent) and five of them had microhole in the right eye. The presenting symptom was decrease in visual acuity (71.3 percent) and central scotoma in (14.3 percent). Five eyes (71.4 percent) had no defects shown by fluorescent angiography. A defect in the outer retina was demonstrated in all eyes on optical coherence tomography. The lesions were nonprogressive. CONCLUSION: Macular microholes are small lamellar defects in the outer retina. The condition is nonprogressive, generally unilateral and compatible with good visual acuity. Fundus biomicroscopy associated with an optical coherence tomography are the main elements in the diagnosis and study of this pathology.

Management of traumatic macular holes: case report / Tratamento do buraco macular traumático: relato de caso

Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.

O buraco macular traumático é doença cuja patogênese não é totalmente esclarecida e a melhor conduta terapêutica ainda é controversa. Relatamos 2 casos de buraco macular traumático para os quais adotamos condutas diferentes. No primeiro caso, um menino de 9 anos apresentou buraco macular traumático secundário a trauma ocular contuso com uma pedra, com visão inicial de 20/300. Foi submetido a tratamento cirúrgico e obteve visão final igual a 20/70 com buraco fechado após 1 ano de seguimento. No segundo caso, mulher de 20 anos sofreu traumatismo penetrante por projétil de arma de fogo na fronte, do lado esquerdo. O trauma causou avulsão do nervo óptico no olho esquerdo com perda de percepção luminososa neste olho. No olho direito apresentou buraco macular traumático e sinais sugestivos de coriorretinite esclopetária, com acuidade visual igual a 20/60. O caso foi inicialmente observado e a visão melhorou para 20/30 com diminuição do diâmetro do buraco. A visão e o diâmetro do buraco mantiveram-se estáveis por 8 meses.

Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna / Functional outcome and macular index in macular hole patients who underwent surgery with internal limiting membrane removal

OBJETIVOS: Avaliar o resultado funcional e o índice macular dos portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna. MÉTODOS: Quinze olhos de 15 pacientes com buraco macular estágios 2, 3 e 4 foram incluídos no estudo. Todos foram submetidos à cirurgia de buraco macular convencional com remoção da membrana limitante interna corada pelo azul de tripan. Melhor acuidade visual com correção e cortes transversais medidos por tomografia de coerência óptica (OCT) foram avaliados no pré- e pós-operatório. O índice macular (razão entre a altura e base do buraco macular) foi calculado e correlacionado com o diâmetro mínimo do buraco macular e o ganho de acuidade visual pós-operatória. RESULTADOS: Obteve-se fechamento do buraco macular em todos pacientes operados. Em 86,7 por cento, houve ganho de pelo menos três linhas de visão. O índice macular demonstrou correlação negativa significante com o diâmetro mínimo (r=0,811). Não foi observada correlação significante entre o índice macular e o ganho de acuidade visual pós-operatória (r=0,351). CONCLUSÃO: Os resultados funcionais na cirurgia do buraco macular com remoção da membrana limitante interna foram bons neste grupo de pacientes. O índice macular demonstrou ser compatível com a configuração espacial do buraco macular, porém não foi preditor de resultados visuais.

PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT) were evaluated pre- and postoperatively. The macular hole index (ratio of hole height to base diameter of the hole) was calculated and correlated with minimum diameter of the macular hole and postoperative gain in visual acuity. RESULTS: Macular hole closure was observed in all operated patients. In 86.7 percent, there was a visual gain of at least three lines. Macular hole index was significantly negative correlated with the minimum diameter of the macular hole (r=0.811). There was no significant correlation between macular index and postoperative gain in visual acuity (r=0.351). CONCLUSION: Functional outcomes with internal limiting membrane removal were good in this group of patients. Macular index was compatible with spatial configuration of the macular hole, however visual outcomes were not predictable.

Emprego das medidas anatômicas do buraco macular idiopático obtidas pela tomografia de coerência óptica como fator preditivo nos resultados visuais: um estudo piloto / Use of anatomical measures of idiopathic macular hole obtained through optical coherence tomography as a predictive factor in visual results: a pilot study

OBJETIVO: Avaliar a anatomia do buraco macular idiopático (BMI) a partir da tomografia de coerência óptica (OCT) e construir índice prognóstico que possa ser correlacionado com os resultados visuais e o fechamento anatômico. MÉTODOS: Estudo prospectivo, no qual 22 olhos com BMI foram avaliados pelo OCT no pré-operatório da cirurgia do BMI. Foi criado o índice prognóstico do buraco macular (IPBM) que foi correlacionado com o resultado anatômico e a acuidade visual pós-operatória seis meses após a cirurgia. RESULTADOS: Dezesseis olhos (72,7 por cento) obtiveram fechamento anatômico ao final de seis meses de acompanhamento. Na análise do IPBM, houve diferença significativa entre o grupo 1 (BM aberto) e o grupo 2 (BM fechado) (p=0,0018). O risco de insucesso para o fechamento anatômico é 11 vezes maior quando o diâmetro da base interna for superior a 600 µm ou o IPBM for inferior a 0,6 (p=0,0495). No que diz respeito à AV final, observou-se que o IPBM tem correlação negativa significante na AV (p=0,001). CONCLUSÃO: O IPBM se apresentou como o melhor preditor de fechamento anatômico e acuidade visual pós-operatória entre as variáveis aqui estudadas. Responde por 41 por cento da acuidade visual pós-operatória final, nos levando a crer que outros fatores, como o tempo de história e a degeneração dos fotorreceptores nestes BM mais antigos, possam estar envolvidos nos resultados visuais.

PURPOSE: To evaluate the anatomy of idiopathic macular hole (IMH) using Optical Coherence Tomography (OCT) and to construct a prognostic index that can be correlated with the visual outcomes and the anatomical closing. METHODS: Prospective study, in which 22 eyes with IMH had been evaluated through OCT in the daily postoperative period of IMH surgery. The Prognostic of Macular Hole Index (PMHI) was created which was correlated with the anatomical result and the postoperative visual acuity (VA) six months after surgery. RESULTS: Sixteen eyes (72.7 percent) got anatomical closing at the end of six months of follow-up. On analysis of PMHI, there was significant difference between group 1 (open MH) and group 2 (closed MH) (p=0.0018). The risk for failure of anatomical closing is 11 times greater when the diameter of the internal base is over 600 µm or IPBM is less than 0.6 (p=0.0495). Regarding final VA, it was observed that the IPBM had a significant negative correlation with AV (p=0.001). CONCLUSIONS: IPBM showed to be the best predictor of anatomical closing and postoperative visual acuity among the studied variables. It predicted 41 percent of the postoperative final visual acuity, leading us to believe that other factors, such as the time of history and the degeneration of photoreceptors in these older BM, can be involved in the visual outcomes.

Quistes maculares nducidos por descarga eléctrica / Macular cyst induced by electric shock

En el presente caso se describe quistes maculares bilaterales secundarios a descarga eléctrica, los cuales fueron diagnosticados por medio de una Tomografía Óptica Coherente y donde se evidencio el diagnóstico diferencial entre quistes maculares y agujeros maculares siendo la OCT una útil herramienta en este caso.

Laser Photocoagulation as Adjuvant Therapy to Surgery for Large Macular Holes

PURPOSE: To evaluate the effectiveness of laser photocoagulation as adjuvant therapy in the treatment of large macular holes. METHODS: A randomized clinical trial. Thirty-one eyes from 29 subjects with idiopathic macular holes of diameters larger than 400 micrometer were randomized into a laser group and a control group. All eyes underwent vitrectomy with peeling of the internal limiting membrane. Contrary to the control group eyes, the laser group eyes underwent laser photocoagulation at the center of the macular hole before vitrectomy. Visual acuity and anatomic outcomes assessed by optical coherence tomography (OCT) were analyzed 3 months after surgery. RESULTS: On postoperative OCT, closure of the macular hole was noted in 17 of the 18 (94.4%) laser group eyes and 10 of the 13 (76.9%) control group eyes. Hole closure without bare retinal pigment epithelium was observed in 16 eyes in the laser group and 6 eyes in the control group (P<0.05). The amount of improvement in logMAR visual acuity 3 months after surgery was 0.40+/-0.29 in the laser group, and 0.19+/-0.23 in the control group (P<0.05). CONCLUSIONS: Laser photocoagulation constitutes a potent adjuvant therapy that may improve anatomical and visual outcomes of surgery for macular holes larger than 400 micrometer.

Visual outcome and electron microscopic features of indocyanine green-assisted internal limiting membrane peeling from macular hole of various aetiologies.

PURPOSE: To describe the visual outcome of internal limiting membrane (ILM) peeling for macular hole of various aetiologies and ultrastructural features of the ILM. MATERIALS AND METHODS: The study was conducted on 40 eyes of 38 patients. Thirty eyes with full thickness macular hole were treated with vitrectomy and removal of ILM. Ten eyes with retinal detachment served as negative controls and these patients underwent vitrectomy and ILM removal. The surgical specimens were examined by transmission electron microscopy. RESULTS: The anatomical success rate of the first operation was 90% in idiopathic and myopic groups, whereas it was 100% in traumatic macular hole group. Visual improvement of (3) two lines was noted in 80% of the cases. Electron microscopy revealed the presence of ILM in all surgical specimens. Proliferation of astrocytes and synthesis of new collagen along the inner surface of ILM was noted in the surgical specimens. CONCLUSION: Our findings suggest that the ILM removal helps in closure of the macular hole and retinal reattachment. Vitrectomy with ILM peeling is a reasonable surgical approach to treat macular holes of idiopathic, myopic and traumatic aetiology.

Remoción o no de la membrana limitante interna en el tratamiento de agujero macular / Removal or not on the internal restrictive membrane in the treatment of macular hole

Evaluar si la remoción de la membrana limitante interna (MLI) en la cirugía de agujero macular idiopático mejora los resultados anatómicos y funcionales de la cirugía. Estudio comparativo retrospectivo, no randomizado, sobre 10 ojos de 10 pacientes con agujero macular estadio III y IV de Gass, operados todos ellos con la misma técnica. En 5 ojos se realizó remoción de la MLI (grupo A) y en los otros 5 sin remoción de la MLI (grupo B). Se evalua la recuperación anatómica y funcional, y las complicaciones de la cirugía en ambos grupos. De los 10 ojos operados se consigue la recuperación anatómica (cierre del agujero) en el 80 por ciento (8 ojos). En el grupo A la recuperación anatómica fue del 100 por ciento los casos, y del 60 por ciento en el grupo B (p=0,016). De todos los ojos operados mejoraron la agudeza visual en una o más líneas de Snellen, 6 ojos (60 por ciento). Se observó mejoría de la agudeza visual en 3 de los 5 ojos del grupo A (60 por ciento), y en el 3 de los 5 ojos del grupo B (60 por ciento). Las complicaciones más importantes fueron el desprendimiento de retina en dos casos del grupo A y un caso del grupo B, la catarata y los cambios a nivel del epitelio pigmentario de retina. En nuestra experiencia la remoción de la MLI en la cirugía del agujero macular mejora los resultados anatómicos, pero no la agudeza visual final. Otros estudios que incluyan un mayor número de pacientes son necesarios para comparar esta técnica de tratamiento con las técnicas convencionales en cuanto a la mejoría de agudeza visual final.

The Effects of Laser Photocoagulation on Reopened Macular Holes, as Assessed by Optical Coherence Tomography

PURPOSE: To evaluate the effects of laser photocoagulation on reopened macular holes. METHODS: This study involved 9 eyes from 9 patients who underwent laser photocoagulation coupled with fluid-gas exchange for reopened macular holes. The photocoagulation was performed at the center of the macular hole. Closure of the reopened hole was categorized by optical coherence tomography (OCT) according to the presence (type 1 closure) or absence (type 2 closure) of continuity in the foveal tissue. Best corrected visual acuity (BCVA), closure types, and complications were assessed. RESULTS: Upon final examination, all macular holes were found to have closed. Six eyes were classified as type 1 closure, and three were classified as type 2 closure. The mean BCVAs, before and after laser photocoagulation, were 0.11 and 0.31, respectively (P< .05). The eyes with type 1 closure were associated with shorter symptom durations and greater visual improvement than those with type 2 closure (P< .05). CONCLUSIONS: The combination of laser photocoagulation and fluid-gas exchange appears to be a safe and effective treatment for reopened macular holes. Early intervention should be encouraged to ensure complete hole closure and improved visual outcomes.

The effect of cryotherapy on proliferative vitreoretinopathy (PVR)

Cryotherapy is implicated for inducing or aggravating proliferative vitreoretinopathy (PVR) by releasing retinal pigment epithelial (RPE) cells. These are based on the fact that PVR rarely occurs in a non-operated eye, and many of the PVR patients have received cryotherapy during surgery. Nonetheless, eyes with diathermy also developed PVR, and although there have been many experiments, the effect of cryotherapy on inducing PVR has not been proven experimentally in the living eye. We made retinal tears in living rabbit eyes, and applied cryotherapy on one eye of each rabbit. The result was compared histologically with the contralateral noncryothermized control eye. There was no statistically significant difference between the two groups concerning the migration of RPE, and the proliferation of RPE. Although the formation of an epiretinal membrane was more obvious in the cryothermized group, the difference was not statistically significant.