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Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study

  • Retinal Disorders
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Abstract

Introduction

Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure.

Methods

Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach.

Results

The mean duration of the MH prior to SR-fluid application was 17 months (6–96 months). The mean age of the patients at the time of surgery was 72 years (54–88). The mean preoperative aperture diameter of the opening was 1212 μm (239–4344 μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01–0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02–0.5). The application of SR-fluid was not associated with major intraoperative adverse effects.

Conclusion

Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.

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References

  1. Ip MS, Baker BJ, Duker JS, Reichel E, Baumal CR, Gangnon R, Puliafito CA (2002) Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography. Arch Ophthalmol 120:29–35

    Article  Google Scholar 

  2. Haritoglou C, Reiniger IW, Schaumberger M, Gass CA, Priglinger SG, Kampik A (2006) Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane: update of a prospective study. Retina 26:618–622

    PubMed  Google Scholar 

  3. Cillino S, Cillino G, Ferraro LL, Casuccio A (2016) Treatment of persistently open macular holes with silicone oil (densiron 68) versus C2F6. A prospective randomized study. Retina 36:688–694

    Article  CAS  Google Scholar 

  4. Banker AS, Freeman WR, Azen SP, Lai MY (1999) A multicentered clinical study of serum as adjuvant therapy for surgical treatment of macular holes. Vitrectomy for Macular Hole Study Group. Arch Ophthalmol 117:1499–1502

    Article  CAS  Google Scholar 

  5. Zhang X, Liu J, Yu B, Ma F, Ren X, Li X (2018) Effects of mesenchymal stem cells and their exosomes on the healing of large and refractory macular holes. Graefes Arch Clin Exp Ophthalmol 256:2041–2052

    Article  CAS  Google Scholar 

  6. Michalewska Z, Michalewski J, Dulczewska-Cichecka K, Adelman RA, Nawrocki J (2015) Temporal inverted internal limiting membrane flap technique versus classic inverted ILM flap technique: a comparative study. Retina 35:1844–1850

    Article  Google Scholar 

  7. Grewal DS, Charles S, Parolini B, Kadonosono K, Mahmoud TH (2019) Autologous retinal transplant for refractory macular holes: multicenter international collaborative study group. Ophthalmology 126:1399–1408. https://doi.org/10.1016/j.ophtha.2019.01.02

    Article  PubMed  Google Scholar 

  8. Tam ALC, Yan P, Gan NY, Lam WC (2018) The current surgical management of large, recurrent or persistent macular holes. Retina 38:1263–1275. https://doi.org/10.1097/IAE.0000000000002020

    Article  PubMed  Google Scholar 

  9. Ullrich S, Haritoglou C, Gass C, Schaumberger M, Ulbig MW, Kampik A (2002) Macular hole size as a prognostic factor in macular hole surgery. Br J Ophthalmol 86:390–393

    Article  CAS  Google Scholar 

  10. Miller JB, Yonekawa Y, Eliott D, Kim IK, Kim LA, Loewenstein JI, Sobrin L, Young LH, Mukai S, Vavvas DG (2015) Long-term follow-up and outcomes in traumatic macular holes. Am J Ophthalmol 160:1255–1258.e1. https://doi.org/10.1016/j.ajo.2015.09.004

    Article  PubMed  Google Scholar 

  11. Berinstein DM, Hassan TS, Williams GA, Margherio RR, Ruby AJ, Garretson BR (2000) Surgical repair of full-thickness idiopathic macular holes associated with significant macular drusen. Ophthalmology 107:2233–2239

    Article  CAS  Google Scholar 

  12. Gonvers M, Bovey EH, Wolfensberger TJ (2002) A new surgical approach for the closure of stage 4 macular holes. 4. September 2002, Meeting of the Jules Gonin, Montreux, Switzerland

  13. Oliver A, Wojcik EJ (2011) Macular detachment for treatment of persistent macular hole. Ophthalmic Surg Lasers Imaging 42:516–518. https://doi.org/10.3928/15428877-20110825-01

    Article  PubMed  Google Scholar 

  14. Wong R (2013) Novel surgical technique for closure of large full-thickness macular holes. Retina 33:1977–1979

    Article  Google Scholar 

  15. Meyer CH, Adamkova M, Rodrigues EB, Stanzel EB, Kastl G, Koss MJ (2020) Closure of persisting full thickness macular holes by subretinal fluid application: technical approach and surgical considerations. Klin Monatsbl Augenheilkd. https://doi.org/10.1055/a-1120-8673. Accessed 14 Apr 2020

  16. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E et al (2013) The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 120:2611–2619

    Article  Google Scholar 

  17. Rodrigues EB, Meyer CH, Kroll P (2005) Chromovitrectomy: a new field in vitreoretinal surgery. Graefes Arch Clin Exp Ophthalmol 243:291–293

    Article  Google Scholar 

  18. Takahashi K, Morizane Y, Hisatomi T, Tachibana T, Kimura S, Hosokawa MM, Shiode Y, Hirano M, Doi S, Toshima S, Araki R, Matsumae H, Kanzaki Y, Hosogi M, Yoshida A, Sonoda KH, Shiraga F (2018) The influence of subretinal injection pressure on the microstructure of the monkey retina. PLoS One 13(12):e0209996. https://doi.org/10.1371/journal.pone.0209996 eCollection 2018

    Article  PubMed  PubMed Central  Google Scholar 

  19. Deramo VA, Meyer CH, Toth CA (2001) Successful macular translocation with temporary scleral infolding using absorbable suture. Retina 21:304–311

    Article  CAS  Google Scholar 

  20. Koss MJ, Falabella P, Stefanini FR, Pfister M, Thomas BB, Kashani AH, Brant R, Zhu D, Clegg DO, Hinton DR, Humayun MS (2016) Subretinal implantation of a monolayer of human embryonic stem cell-derived retinal pigment epithelium: a feasibility and safety study in Yucatán minipigs. Graefes Arch Clin Exp Ophthalmol 254:1553–1565. https://doi.org/10.1007/s00417-016-3386-y

    Article  CAS  PubMed  Google Scholar 

  21. Lytvynchuk LM, Falkner-Radler CI, Krepler K, Glittenberg CG, Ahmed D, Petrovski G, Lorenz B, Ansari-Shahrezaei S, Binder S (2019) Dynamic intraoperative optical coherence tomography for inverted internal limiting membrane flap technique in large macular hole surgery. Graefes Arch Clin Exp Ophthalmol 257:1649–1659

    Article  Google Scholar 

  22. Maier M, Bohnacker S, Klein J, Klaas J, Feucht N, Nasseri A, Lohmann CP (2019) Vitrectomy and iOCT-assisted inverted ILM flap technique in patients with full thickness macular holes. Ophthalmologe 116:617–624. https://doi.org/10.1007/s00347-018-0769-y

    Article  CAS  PubMed  Google Scholar 

  23. Claes CC (2019) Internal repair of very large, myopic and recurrent macular holes by creation of a central retinal detachment and silicone oil tamponade. Retina 39(Suppl 1):S72–S73. https://doi.org/10.1097/IAE.0000000000001767

    Article  PubMed  Google Scholar 

  24. Kumar A, Tinwala SI, Gogia V, Sehra SV (2013) Tapping of macular hole edges: the outcomes of a novel technique for large macular holes. Asia Pac J Ophthalmol 2:305–309. https://doi.org/10.1097/APO.0b013e31829a1919

    Article  Google Scholar 

  25. Miller JJ, Rodriguez FJ, Smiddy WE, Rodriguez A (2007) Macular hole surgery in Alport Syndrome. Retin Cases Brief Rep 1:153–155

    Article  Google Scholar 

  26. Forsaa VA, Lindtjørn B, Kvaløy JT, Frøystein T, Krohn J (2018) Epidemiology and morphology of full-thickness macular holes. Acta Ophthalmol 96:397–404

    Article  Google Scholar 

  27. Menzler J, Neubauer AS, Haritoglou C, Jackson TL (2019) Incidence and prevalence of vitreomacular traction with and without macular hole in Germany. Clin Ophthalmol 13:177–188

    Article  Google Scholar 

  28. Schumann RG, Hagenau F, Guenther SR, Wolf A, Priglinger SG, Vogt D (2019) Premacular cell proliferation profiles in tangential traction vitreo-maculopathies suggest a key role for hyalocytes. Ophthalmologica 242:106–112. https://doi.org/10.1159/000495853

    Article  PubMed  Google Scholar 

  29. Charles S, Randolph JC, Neekhra A, Salisbury CD, Littlejohn N, Calzada JI (2013) Arcuate retinotomy for the repair of large macular holes. Ophthalmic Surg Lasers Imaging Retina 44:69–72

    Article  Google Scholar 

  30. Ruban A, Lytvynchuk L, Zolnikova A, Richard G (2019) Efficiency of the hydraulic centripetal macular displacement technique in the treatment of traumatic full-thickness macular holes. Retina 39:S74–S8310. https://doi.org/10.1097/IAE.0000000000001929

    Article  PubMed  Google Scholar 

  31. Wong R, Howard C, Orobona GD (2018) Retinal expension technique for macular hole apposition report 2: efficacy, closure rate, and risk of a macular detachment technique to close full-thickness macular holes. Retina 38:660–663

    Article  Google Scholar 

  32. Felfeli T, Mandelcorn ED (2019) Macular hydrodissection: surgical technique for the treatment of persistent, chronic, and large macular holes. Retina 39:743–752

    Article  Google Scholar 

  33. Frisina R, Tozzi L, Sabella P, Cacciatori M, Midena E (2019) Surgically Induced macular detachment for treatment of refractory full-thickness macular hole: anatomical and aunctional results. Ophthalmologica 242:98–105

    Article  Google Scholar 

  34. Ch'ng SW, Patton N, Ahmed M, Ivanova T, Baumann C, Charles S, Jalil A (2018) The Manchester Large Macular Hole Study: is it time to reclassify large macular holes? Am J Ophthalmol 195:36–42

    Article  Google Scholar 

  35. Yamashita T, Sakamoto T, Terasaki H, Iwasaki M, Ogushi Y, Okamoto F, Takeuchi M, Yasukawa T, Takamura Y, Ogata N, Nakamura Y writing committee of Japan-Clinical Retina Research Team (J-CREST )(2018) Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan. Acta Ophthalmol 96:e904–e910

    Article  Google Scholar 

  36. Yek JTO, Hunyor AP, Campbell WG, McAllister IL, Essex RW, Australian and New Zealand Society of Retinal Specialists Macular Hole Study Group (2018) Outcomes of eyes with failed primary surgery for idiopathic macular hole. Ophthalmol Retina 2:757–764. https://doi.org/10.1016/j.oret.2017.10.012

    Article  PubMed  Google Scholar 

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Acknowledgement

We like to thank Emma Feloy at Science Animated www.sciani.com for the preparation of the animated instructional video and preparation of screen shorts for this publication. Steven Jones at Proof-Reading-Service.com read and corroded the paper. The corresponding instructional video may be seen on the AAO website (https://www.aao.org/clinical-video/how-to-close-macular-hole-using-subretinal-fluid).

The APOSTEL study received the distinguished Leonhard-Klein Award for ocular surgery 2020 at the Deutsche Ophthalmologische Gesellschaft (DOG).

Author information

Authors and Affiliations

  1. Augenärzte Kammanneye, Davos, Switzerland

    Carsten H. Meyer

  2. Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany

    Peter Szurman

  3. Department of Ophthalmology, Herzog Carl Theodor Eye Clinic, Munich, Germany

    Christos Haritoglou & Michael J. Koss

  4. Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany

    Christos Haritoglou, Armin Wolf & Siegfried Priglinger

  5. Department of Ophthalmology, Technical University of Munich, Munich, Germany

    Mathias Maier

  6. Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany

    Lyubomyr Lytvynchuk

  7. Department of Ophthalmology, University Würzburg, Würzburg, Germany

    Jost Hillenkamp

  8. Department of Ophthalmology, Sankt Gertrauden Krankenhaus, Berlin, Germany

    Joachim Wachtlin

  9. Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland

    Matthias Becker

  10. Department of Ophthalmology, Feldkirch State Hospital, Feldkirch, Austria

    Stefan Mennel

  11. MHB Midizinische Hochschule Brandenburg, Neuruppin, Germany

    Joachim Wachtlin

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  1. Carsten H. Meyer
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Correspondence to Carsten H. Meyer.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the (place name of institution and/or national research committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study treatment.

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This article is part of the Topical Collection on Macular Holes.

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Meyer, C.H., Szurman, P., Haritoglou, C. et al. Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study. Graefes Arch Clin Exp Ophthalmol 258, 2151–2161 (2020). https://doi.org/10.1007/s00417-020-04735-3

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  • DOI: https://doi.org/10.1007/s00417-020-04735-3

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