A retrospective, multicenter study on the management of macular holes without residual internal limiting membrane: the refractory macular hole (ReMaHo) study.

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

Occupational lifting tasks and retinal detachment in non-myopics and myopics: extended analysis of a case-control study.

OBJECTIVES: Lifting heavy weights involves the Valsalva manoeuvre, which leads to intraocular pressure spikes. We used data from a case-control study to further investigate the hypothesis that occupational lifting is a risk factor for retinal detachment. METHODS: The study population included 48 cases (patients operated for retinal detachment) and 84 controls (outpatients attending an eye clinic). The odds ratios (OR) of idiopathic retinal detachment were estimated with a logistic regression model (adjusted for age, sex and body mass index). Three indexes were used to examine exposure to lifting; 1) maximum load lifted, 2) average weekly lifting, 3) lifelong cumulative lifting. RESULTS: For all indexes, the most exposed subjects showed an increased risk of retinal detachment compared with the unexposed (index 1: OR 3.57, 95% confidence interval [CI] 1.21-10.48; index 2: OR 3.24, 95% CI 1.32-7.97; index 3: OR 2.23, 95% CI 1.27-8.74) and dose-response relationships were apparent. CONCLUSION: These results reinforce the hypothesis that heavy occupational lifting may be a relevant risk factor for retinal detachment.

Physical exertion (lifting) and retinal detachment among people with myopia.

BACKGROUND: People with myopia (near sightedness) are at increased risk for retinal detachment. We explored other factors that may be associated with retinal detachment within this high-risk group. METHODS: We conducted a case-control study comprising 61 cases with retinal detachment and myopia and 99 hospital controls who also had myopia. Cases were recruited from a general hospital, and controls from ophthalmologic clinics. Participants compiled a questionnaire including details of past and current occupational lifting tasks to explore Valsalva maneuver as a possible risk factor. We devised a cumulative lifting index to distinguish light and heavy lifting. RESULTS: After adjusting for potential confounders, we found strong associations of retinal detachment with eye surgery, eye or head trauma, severe myopia (all known risk factors), and heavy lifting (vs. no lifting, odds ratio = 4.4 [95% confidence interval = 1.5-13]) and high body mass index (>or=25.5 kg/m, 6.8 [1.6-29]). CONCLUSIONS: Heavy occupational lifting and being overweight may be important risk factors for retinal detachment among people with myopia. The role of these risk factors in the etiology of retinal detachment deserves to be explored in more general populations.