Addslide Macular Hole presentation pptx.

macular hole

1. Keberhasilan operasi dinilai dari perbaikan visus dan penutupan lubang Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.

2. Caporossi , Tomaso, Matteo Mario Carlà , Gloria Gambini, Umberto De Vico , Antonio Baldascino , and Stanislao Rizzo. 2022. “Spotlight on the Internal Limiting Membrane Technique for Macular Holes: Current Perspectives.”  Clinical Ophthalmology (Auckland, N.Z.)  16: 1069–84. https://doi.org/10.2147/OPTH.S284620.

3. Keberhasilan ILM Peeling Caporossi , Tomaso, Matteo Mario Carlà , Gloria Gambini, Umberto De Vico , Antonio Baldascino , and Stanislao Rizzo. 2022. “Spotlight on the Internal Limiting Membrane Technique for Macular Holes: Current Perspectives.”  Clinical Ophthalmology (Auckland, N.Z.)  16: 1069–84. https://doi.org/10.2147/OPTH.S284620.

4. Dyes Indocyanine Green (ICG) Trypan Blue (TB) Brilliant Blue (BB) Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

5. Indocyanine Green (ICG) Still widely used, despite concerns regarding its safety Has selective affinity for the ILM and was initially used at the concentration of 0.5%, but because of changes in the RPE and visual field defects, this concentration was reduced to 0.125% and even 0.05%, which makes the staining paler but still useful. Opinion among vitreoretinal surgeons remains divided on the possible toxicity of ICG application to the retina. Should therefore only be used at the minimal concentrations of 0.025–0.05% (0.25–0.5 mg/ mL) and for a very short time.

6. Trypan Blue (TB) Trypan blue (TB) stains the ERM well but the ILM less effectively. Remains an alternative to ICG. To improve TB staining of the ILM, it must be used after fluid–gas exchange. In most studies, Trypan blue gave no signs of toxicity for the RPE or for neuronal tissue.

7. Brilliant Blue (BB) Brilliant Blue (BB) has a selective affinity for the ILM and gives good staining in an iso-osmolar solution of 0.25 mg/mL (0.025%). The staining occurs after a brief contact with the dye injected onto the retinal surface. In animal experiments, the safety profile of BB was good, and it seems the best alternative to ICG

8. Pertimbangan Lain untuk Operasi Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.

9. Recent Macular Holes The best anatomic and visual prognosis occurs in eyes with recent-onset macular holes of 250 µm or less (these are typically less than 6 months in duration), as these eyes presumably have less damage to the foveal photoreceptors than do eyes with older macular holes.

10. Intermediate Macular Holes Eyes with intermediate duration macular holes (these are often 6–24 months in duration) still have a reasonably good prognosis and macular hole surgery is still indicated, but the visual results do not tend to be as good as in eyes with more recent macular holes These macular holes are often in the range of 250 to 500 µm.

11. Chronic Macular Holes Chronic macular holes (more than 2 years’ duration) are more difficult to close, and the visual results tend to be less favorable The decision whether or not to recommend vitreous surgery for an eye with a chronic macular hole is based on several factors, including the visual needs of the patient, status of the fellow eye, and estimated duration of the macular hole. Macular holes older than 5 years can sometimes be closed successfully, but the visual acuity rarely improves substantially; therefore, in general, patients with such old macular holes should not receive surgery as most will not experience further decreases in visual acuity if nothing is done

12. Choice of Tamponade The rationale for preferring one gas to another is based on the expected duration of the gas bubble. If we assume that most MH close within 3–7 days of tamponade, a bubble large enough to insulate the macula from intraocular fluid during this period will be sufficient. This, for instance, is the case for a 17% C2F6–air mixture, provided the vitrectomy is large enough to create a large gas bubble. With this mixture, the gas bubble still covers the macula 1 week after surgery if the head is in the upright position, and still fills more than 70% of the vitreous cavity.

13. If the hole is small and a 3-day tamponade is assumed to be sufficient, 20% SF6–air, or even air alone, might be enough, but it may be preferable for the patient to remain facedown during that time.

14. Silicone Oil Silicone oil has been used to avoid the need for positioning in patients unable to maintain the facedown position, to allow air travel after surgery, or to ensure prolonged tamponade in case of failure of the initial surgery. In such cases, some authors stressed the advantages of the use of silicone oil, which gave good results. Others noted that the anatomic results were no better with silicone oil than with gas, or that the visual results were worse.

15. Edukasi Some small stage 2 macular holes will close spontaneously, so it is reasonable to follow up a patient for a month with a small stage 2 macular hole, minimal symptoms, good visual acuity (20/30 or better), and vitreous traction to the flap at the edge of the macular hole. If the macular hole is monitored and increases in size with decreasing visual acuity, it is reasonable to consider vitrectomy. The visual needs of the patient and symptoms are important criteria that help to determine the recommended timing of macular hole surgery.

16. Complications Retinal Tears/Detachment RPE Alterations Visual Field Loss Persistent/Recurrent Macular Holes Cataracts Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.

17. Retinal Tears/Detachment The rate of retinal detachment is variable and ranges from 1.2% in one series to 14% in another contemporaneous series using 20-gauge vitrectomy. Meticulous examination of the peripheral retina is essential before fluid–gas exchange because the creation of a posterior vitreous detachment. About two thirds of these iatrogenic retinal breaks are located in the inferior retina and are created during creation or extension of a posterior vitreous detachment. These breaks have been attributed to the traction exerted by the gas bubble on the inferior vitreous in the upright position. It is very important to prevent a retinal detachment, as detachment of the macula may cause reopening of the macular hole.

18. RPE Alterations These RPE changes are a combination of RPE atrophy (seen on fundus examination) and pigment clumping (FFA). Most common causes of the RPE atrophy are mechanical damage to the macula with ILM peeling phototoxicity from the light pipe ICG toxicity to the RPE

19. Visual Field Loss Patients in whom visual field loss develops generally notice an inferotemporal visual field defect as the gas bubble is being absorbed. These visual field defects are usually due to dehydration injury to the macula and result from the jet stream of air from the infusion cannula against the nerve fiber layer.

20. Persistent/Recurrent Macular Holes Sometimes the glial plug that normally closes the macular hole never develops, so the hole reopens once the macular hole is again exposed to a vitreous filled with fluid. Reopening of the hole months or years after its closure, has been attested on OCT, and has been found to occur in 5–7% of cases -- might be the proliferation of a secondary ERM around the hole

21. Golden Period? Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.

22. Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

23. Williamson, Thomas H. 2022.  Vitreoretinal Surgery . 3rd ed. Cham, Switzerland: Springer Nature. Grade 1 Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.

24. Grade 1b Williamson, Thomas H. 2022.  Vitreoretinal Surgery . 3rd ed. Cham, Switzerland: Springer Nature.

25. Grade 2 Williamson, Thomas H. 2022.  Vitreoretinal Surgery . 3rd ed. Cham, Switzerland: Springer Nature. Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.

26. Grade 3 Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.

27. Williamson, Thomas H. 2022.  Vitreoretinal Surgery . 3rd ed. Cham, Switzerland: Springer Nature.

28. Williamson, Thomas H. 2022.  Vitreoretinal Surgery . 3rd ed. Cham, Switzerland: Springer Nature.

29. Gold Standard? Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical. Tinwala , Sana I. 2018. “Optical Coherence Tomography: Essential Tool in Macular Hole Management.” In  OCT - Applications in Ophthalmology . InTech .

30. Differential Diagnosis Lamellar Macular Holes Macular Pseudoholes

31. Macular Pseudoholes The epiretinal membrane creates a white-yellow sheen surrounding the fovea, which makes the fovea appear dark like a macular hole Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.

32. Lamellar Macular Holes A macular lesion resulting from the opening of the central cyst of a cystoid macular edema Defects in the inner fovea due to the avulsion of the roof of a foveal cyst OCT : irregular thinning of the foveal floor, a cleavage between the inner and outer retina at the lamellar hole edge, and the absence of a contractile epiretinal membrane. Color photograph showing a roundish, lobulated, red central area corresponding to the thinning of the fovea after avulsion of the roof of a foveal cyst. OCT scan showing the irregular base of the lamellar hole and the cleft between the inner and outer retina inside the edge of the lamellar hole (blue arrow). Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

33. Dyes Indocyanine Green (ICG) Trypan Blue (TB) Brilliant Blue (BB) Triamcinolone acetate

34. Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

35. Williamson, Thomas H. 2022.  Vitreoretinal Surgery . 3rd ed. Cham, Switzerland: Springer Nature.

36. Area of ILM peeling Boyd, Samuel. 2010.  Retinal and Vitreoretinal Diseases and Surgery . Jaypee Highlights. Williamson, Thomas H. 2022.  Vitreoretinal Surgery . 3rd ed. Cham, Switzerland: Springer Nature.

37. Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

38. Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

39. Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

40. Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

41. Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby .

42. ILM Peeling Complications

43. Prognoses for MH in High Myopia Ryan, Stephen J., Thomas E. Ogden, David R. Hinton, Andrew P. Schachat , and Charles P. Wilkinson. 2001.  Retina . 3rd ed. London, England: Mosby . Scott, Ingrid, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2017.  Vitreoretinal Disease: Diagnosis, Management, and Clinical Pearls . Edited by Ingrid U. Scott, Carl D. Regillo , Harry W. Flynn, and Gary C. Brown. 2nd ed. New York, NY: Thieme Medical.