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Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy

Persistent idiopathic macular hole (PIMH), the occurrence of idiopathic macular holes that have failed to close after standard pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, has become a global health threat to the aging population. Because postoperative anatomic closure...

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Autores principales: Shi, Yunhong, Feng, Lujia, Li, Yangyang, Jiang, Zhihao, Fang, Dong, Han, Xiaotong, Wang, Lanhua, Wei, Yantao, Zhang, Ting, Zhang, Shaochong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414988/
https://www.ncbi.nlm.nih.gov/pubmed/37575988
http://dx.doi.org/10.3389/fmed.2023.1169776
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author Shi, Yunhong
Feng, Lujia
Li, Yangyang
Jiang, Zhihao
Fang, Dong
Han, Xiaotong
Wang, Lanhua
Wei, Yantao
Zhang, Ting
Zhang, Shaochong
author_facet Shi, Yunhong
Feng, Lujia
Li, Yangyang
Jiang, Zhihao
Fang, Dong
Han, Xiaotong
Wang, Lanhua
Wei, Yantao
Zhang, Ting
Zhang, Shaochong
author_sort Shi, Yunhong
collection PubMed
description Persistent idiopathic macular hole (PIMH), the occurrence of idiopathic macular holes that have failed to close after standard pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, has become a global health threat to the aging population. Because postoperative anatomic closure or restoration of visual acuity is more difficult to achieve in PIMH, surgical approaches that would yield the best outcomes remain to be elucidated. On paper, extended ILM peeling combined with silicone oil (SiO) tamponade is believed to be a feasible option for excellent macular hole closure. However, no studies on this combined treatment for PIMH is compared with simple air tamponade have been conducted. Thus, in this retrospective case series, we used spectral-domain optical coherence tomography (SD-OCT) and other technologies to investigate real-world evidence for the anatomical and functional outcomes of revisional PPV with either SiO or air tamponade for failed primary idiopathic macular hole surgery. We included the records of 76 patients with PIMH who had SD-OCT examinations and best-corrected visual acuity (BCVA). Regression analysis was performed to find factors affecting PIMH fracture closure. Seventy-six participants were allocated to a SiO group (n = 21, with an extended ILM peeling and SiO tamponade) or an air group (n = 55, with extended ILM peeling and air tamponade). Anatomical success was achieved in 18 (85.7%) and 40 (72.7%) eyes in the SiO and air groups, respectively (p = 0.37). BCVA was significantly improved in both subgroups of closed PIMH (SiO group: p = 0.041; air group: p < 0.001). Minimum linear diameter (MLD) was closely related to the closure rate (OR, 1.0; 95% CI (0.985–0.999); p = 0.03). MLD = 650 μm seemed like a cut-off point for closure rate (MLD ≤ 650 μm vs. MLD > 650 μm; 88.4% vs. 52%, p = 0.002). In conclusion, we demonstrated that extended ILM peeling combined with SiO or air tamponade is effective in PIMH treatment. Moreover, though not statistically significant herein, the anatomic closure rate was better for silicone-operated eyes than for air-operated eyes. MLD is the best predictor of PIMH closure; MLD ≤ 650 μm could achieve a significantly higher closure rate.
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spelling pubmed-104149882023-08-11 Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy Shi, Yunhong Feng, Lujia Li, Yangyang Jiang, Zhihao Fang, Dong Han, Xiaotong Wang, Lanhua Wei, Yantao Zhang, Ting Zhang, Shaochong Front Med (Lausanne) Medicine Persistent idiopathic macular hole (PIMH), the occurrence of idiopathic macular holes that have failed to close after standard pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, has become a global health threat to the aging population. Because postoperative anatomic closure or restoration of visual acuity is more difficult to achieve in PIMH, surgical approaches that would yield the best outcomes remain to be elucidated. On paper, extended ILM peeling combined with silicone oil (SiO) tamponade is believed to be a feasible option for excellent macular hole closure. However, no studies on this combined treatment for PIMH is compared with simple air tamponade have been conducted. Thus, in this retrospective case series, we used spectral-domain optical coherence tomography (SD-OCT) and other technologies to investigate real-world evidence for the anatomical and functional outcomes of revisional PPV with either SiO or air tamponade for failed primary idiopathic macular hole surgery. We included the records of 76 patients with PIMH who had SD-OCT examinations and best-corrected visual acuity (BCVA). Regression analysis was performed to find factors affecting PIMH fracture closure. Seventy-six participants were allocated to a SiO group (n = 21, with an extended ILM peeling and SiO tamponade) or an air group (n = 55, with extended ILM peeling and air tamponade). Anatomical success was achieved in 18 (85.7%) and 40 (72.7%) eyes in the SiO and air groups, respectively (p = 0.37). BCVA was significantly improved in both subgroups of closed PIMH (SiO group: p = 0.041; air group: p < 0.001). Minimum linear diameter (MLD) was closely related to the closure rate (OR, 1.0; 95% CI (0.985–0.999); p = 0.03). MLD = 650 μm seemed like a cut-off point for closure rate (MLD ≤ 650 μm vs. MLD > 650 μm; 88.4% vs. 52%, p = 0.002). In conclusion, we demonstrated that extended ILM peeling combined with SiO or air tamponade is effective in PIMH treatment. Moreover, though not statistically significant herein, the anatomic closure rate was better for silicone-operated eyes than for air-operated eyes. MLD is the best predictor of PIMH closure; MLD ≤ 650 μm could achieve a significantly higher closure rate. Frontiers Media S.A. 2023-07-27 /pmc/articles/PMC10414988/ /pubmed/37575988 http://dx.doi.org/10.3389/fmed.2023.1169776 Text en Copyright © 2023 Shi, Feng, Li, Jiang, Fang, Han, Wang, Wei, Zhang and Zhang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Shi, Yunhong
Feng, Lujia
Li, Yangyang
Jiang, Zhihao
Fang, Dong
Han, Xiaotong
Wang, Lanhua
Wei, Yantao
Zhang, Ting
Zhang, Shaochong
Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy
title Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy
title_full Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy
title_fullStr Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy
title_full_unstemmed Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy
title_short Outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy
title_sort outcomes of revision surgery for idiopathic macular hole after failed primary vitrectomy
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414988/
https://www.ncbi.nlm.nih.gov/pubmed/37575988
http://dx.doi.org/10.3389/fmed.2023.1169776
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