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Double Inverted Flap Technique for Stage IV MH

Aim: To present a modification of the conventional inverted flap technique in stage IV macular hole surgery. Technique: After a core vitrectomy and trypan blue-assisted ILM peeling. Two vertical tears were created, temporal and nasal, to the fovea. Boht flaps were folded over the fovea creating a large ILM peeling. Air fluid exchange was followed by SF6 25% injection. Results: Six eyes of 6 patients were treated with this technique and...

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My Way to Perform the Inverted Flap Technique for MH

Introduction: Full-thickness idiopathic macular holes are foveal anatomic defects with a complete interruption of all retinal layers. This results in a significant visual impact for the patient. Current surgical options are constantly under debate, particularly after the new International Vitreomacular Traction Study Group classification. Various surgical options have been proposed to boost the closure rates in this disorder, namely...

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Why Did I Choose the Inverted ILM Flap Technique?

Simple surgical maneouver. Better anatomical results. Earlier visual recovery. Large and difficult macular holes may be succesfully closed with this technique. No additional equipment/ dye etc. is necessary. Enables hole closure in different indications (traumatic, high myopia). It allows succesful treatment of myopic macular hole with retinal detachment. Reoperations are predictable, logic and easy to perform. Temporal inverted ILM...

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Morpho-functional Evaluation of the Ganglion Cell Complex After MH and ILM Peeled with Tano Diamond Scrapper

To evaluate the functionality and the thickness of the ganglion cell complex (GCC) in sixteen patients with full-thickness macular hole underwent ILM peeling and scraping with Tano Diamond Duster Membrane Scraper (DDMS). Three-port pars plana vitrectomy with a 23-gauge system was performed with ILM peeling. After Dual Blue staining, air was used as tamponade. Before performing fluid/air exchange, the hole edges were repeatetdly massaged...

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3 Cases of MH that Lately Closed when the Patient Respected his Positioning

Macular hole are frequently operated using gas tamponnade, requiring a face-down positioning. However, some suggest that this positioning is not so important whereas others consider that tamponnading is not necessary. In the EVRS MH study, we showed that 85% of macular holes would close; ranging from 95% in small holes to 40% in complex situations. However, patients are frequently complaining about the face-down positioning,...

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A Wrong Decision: Surgery of Lamellar Retinal Hole (A Case Report)

SCIENTIFIC POSTER 2016_A Wrong Decision Surgery of Lamellar Retinal Hole (A Case Report) Lidmila Prochazkova Objective: Our case report presents the course of a lamellar hole surgery and subsequent macular hole surgeries in a female patient aged 56 years. Introduction: Macular hole is a fovea defect in full thickness. It is caused by both tangential and saggital traction of posterior hyaloid in macular area. Macular hole progressively...

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Full Thickness MH After ND-YAG Laser Posterior Capsulotomy: The Importance of Evaluation of Vitreoretinal Interface

SCIENTIFIC POSTER 2016_Full Thickness MH After ND-YAG Laser Posterior Capsulotomy The Importance of Evaluation of Vitreoretinal Interface Umut Karaca Purpose: To present a case of full-thickness macular hole (FTMH) formation after Nd-YAG laser posterior capsulotomy, and discuss the underlying pathology. Case Report: A 60-year-old male patient followed for dry age related macular degeneration underwent Nd-YAG laser posterior capsulotomy for...

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Inverted ILM Flap Technique for MH in High Myopia: A Case Report

Purpose: To report the surgical technique and efficacy of the inverted internal limiting membrane (ILM) flap technique for an idiopathic macular hole (MH) in high myopia. Case presentation: A 47-year-old female with a full thickness macular hole with foveoschisis underwent pars plana vitrectomy with 23 gauge plus transconjunctival system, ILM peeling and SF6 gas tamponade. Axial length was 29.96mm and best corrected visual acuity was 0.06...

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Five Year Old MH After Multiple Surgeries for RD

Contact Details: Email: jerzy_n@poczta.onet.pl Cell Phone: /+48606379620

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Three Year Old MH

Contact Details: Email: ddd@club-internet.fr Cell Phone: /+33685555202

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Secondary Surgery in MH Failures

MH surgery remains one of the most frequently performed surgery. It is usually successful when performed earlier and when MH diameter does not exceed 500 um. There are several techniques used to ensure the success after MH surgery in long standing cases or big macular holes. There are techniques which use the instrument to put the edges of the hole closer. There are techniques of IOL flap implantation, which remain technically very...

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Large MH Previously Operated

Case of 74 year old woman with large macular hole. After the first operation with classical technique 23G MIVS PPV. Posterior Hyaloid removal, ILM blu staining assisted regulated SF6 endotamponade the hole was not closed and had also raised margins. Rejection of gas bubble and positioning tight for 7 days did not produced the hoped reattachment of the edges and the closure of the hole.Reoperation and tamponade with heavy silicone and...

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Flying Flap

Contact Details: Email: ppnves@gmail.com Cell Phone:...

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Macular Buckling

Pathologic myopic eyes are proned to have choroidal effusions during ocular surgeries. This case had macular hole related retinal detachment who had a previous vitrectomy without success. She was offered to have a macular buckling surgery and vitrectomy. A limited subretinal hemorrhage was noted at the beginning of the surgery. We stopped at that moment and observed the choroidal hemorrhage for 10 minutes. Since it did not tend to enlarge,...

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OCT Analysis in Case of Spontaneous MH After Silicone Oil Removal in PDVR B Case

Piotr Fryczkowski_SCIENTIFIC POSTER 2015 Case of proliferative diabetic vitreoretinopathy in 38 year old male with juvenile diabetes. Poster shows spontaneous macular hole formation with macular detachment in OCT one month after silicone oil removal. We reject vitrectomy as a treatment because in the first operation ILM was removed up to the temporal arcades. After double injections of 25% SF6 macula attached, and the hole remains flat...

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Topographic Changes of the Macula After Closure of Macular Hole

Kang Yeun Pak_SCIENTIFIC POSTER 2015 Purpose: To investigate the topographic changes of the macula after closure of macular hole (MH) using vitrecotmy and the internal limiting membrane peeling. Methods: The custom program was used to compare the position of the retinal vessels in the macula between pre- and postoperation. Fundus photographs before and after MH surgery were selected for the following analysis, only if the same fundus camera...

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Efficacy of Idiopathic Macular Hole Retreatment After Primary Pars Plana Vitrectomy

Martina Rubesova_SCIENTIFIC POSTER 2015 Purpose: The aim of this study was to evaluate the efficacy of retreatment of macular hole in patients in whom primary pars plana vitrectomy (PPV) did not lead to the anatomical closure of the full-thickness defect, and to analyse the causes of its failure. Methods: Patients after primary surgical treatment by pars plana vitrectomy with a peeling of internal limiting membrane (IML) and gas tamponade...

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Perfluoro-n-octane Assisted ILM Free Flap Technique for Recurrent MH

It is challenging to achieve hole closure in chronic large macular holes or highly myopic eyes. Recently, various surgical techniques have been introduced using the ILM, and we also reported a technique to cover a macular hole with a Internal Limiting Membrane (ILM) inverted flap as a single layer using Perfluoro-n-octane(PFO). However, these procedures are not feasible f or recurrent macular hole that the ILM around the macular hole has...

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Idiopathic Macular Hole: A Funny Trick and Different Inverted ILM Flap Techniques

Introduction: Idiopathic full thickness macular holes are foveal anatomic defects with interruption of all neurosensory retinal layers, resulting in visual and functional alterations with significant impact on the patient’s quality of life. Currently, the best therapeutic approach for macular holes is still being debated, after the new classification by the International Vitreomacular Study Group. Several surgical methods have been...

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ILM Peeling with and Without Adjunctive Triamcinolone – Did the ME Study Make a Difference ?

Background: Before the EVRTS-Meeting in Dresden 2012 we always used adjunctive Triamcinolone at the end of epiretinal membrane surgery with ILM-peeling, thinking, that this would reduce postoperative macular edema. However, in reaction to the results of the ME-Study, published in Dresden in 2012 which suggest that cortisone hinders the edema-lowering effect of ILM-peeling, we discontinued the use of adjunctive Triamcinolone in all cases...

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MH Formation in a Patient with PVD

We present a case of a 53 year old male who had macular hole surgery in the left eye. The right eye of the patient had a normal macular examination with posterior vitreous detachment confirmed with Optical Coherence Tomography. During follow up we observed a macular hole formation. Our case is a good demonstration of macular hole formation occurred with the tangential forces in a patient with complete posterior vitreous detachment.

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Visual and Structural Outcome of MH Surgery

SCIENTIFIC POSTER_Vanessa Lemos Purpose: To evaluate the visual and structural outcomes of macular hole (MH) surgery and its correlation with base diameter, height and minimum linear diameter of MH. Methods and Materials: This retrospective study included a total of 44 eyes (41 patients) with idiopathic MH underwent pars plana vitrectomy, internal limiting membrane peeling and intraocular gas tamponade with a mininum follow-up period of 6...

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Characteristics and Surgical Outcome of MH Developed After RRD Repair

SCIENTIFIC POSTER_Joo Yeon Kim Purpose: To report the characteristics and surgical outcomes of macular holes (MHs) that develop after rhegmatogenous retinal detachment (RD) repair. Methods: A retrospective chart review was performed in patients who developed a full-thickness macular hole after RD repair between May 2010 to July 2013. The eyes underwent MH repair with pars plana vitrectomy, internal limiting membrane peeling and gas...

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Spontaneous Closure of a Myopic MH in a Vitrectomized Eye

We report on a 50 years-old female patient who underwent pars plana vitrectomy for a dropped nucleus and developed thereafter a myopic macular hole. The hole closed spontaneously during follow up. The patient had been referred to our clinic for a dropped nucleus on both eyes, and she underwent subsequent pars plana vitrectomy. We did not implant an intraocular lens because of the high myopic refraction. After surgery her visual acuity was...

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Macular Hole and VMT in Fellow Eye…How to Approach?

A 68-years-old patient,female,with loss of vision in the right eye (count fingers) and symptoms of deterioration visual acuity and distorted vision in the left eye. The OCT showed a full thickeness macular hole in the right eye and a vitreomacular traction in the left eye. The issue in discussion is: The aproach to the right eye. Wich are the options of treatment for the left eye??: Vitrectomy?? Pharmacologic Vitreolysis?? The authors...

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Improvements in Visual Acuity After Treatment of Vitreomacular Traction and Full-Thickness Macular Hole With Ocriplasmin

Advantages: Vitreomacular traction (VMT) is a progressive retinal disorder that can result in visual distortions and loss of vision that until recently did not have a pharmacological treatment option. Phase 3 clinical trials showed that a single intravitreal injection of ocriplasmin (125 µg) results in a significantly higher proportion of patients achieving anatomic resolution of VMT and closure of full-thickness macular hole (FTMH)...

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Temporal Inverted Flap Technique for MH Closure. A Comparative Study

Advantage: The aim of this study is to present the comparative non-randomised study of Temporal Inverted Flap Technique vs. Classic ILM Flap Technique for Macular Hole Closure. Methods: This is a single center, comparative study. 43 eyes of 39 patients mean age 67, were operated with classic ILM Flap technique (Group A) and 44 eyes of 40 patients, mean age 66, were operated on using only a temporal flap of ILM (Group B). In group B, ILM...

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Long Lasting Macular Hole Surgery: My Way

Long lasting macular holes happen in clinical practice and they remain a surgical challenge. EVRS MH study performed in 2013 revealed that failure rate is 4 times higher in long lasting macular holes, so they should be operated as soon as possible. But what to do if the macular hole was not operated at the early stage? How to perform surgery to minimalize the failure rate? There are some controversies as far as triamcinolone use during...

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Reoperation of Failed MH Closure

Problem: Postoperative persistentmacular hole after standard surgery with ILM peeling is a rare but possible finding. The strategy for further treatment is still under debate and ample treatment recommendations have been published. The aim is to report the surgical outcome with the radial retinal incisions technique. Methods: Sseven eyes underwent a second procedure in which five full-thickness neurosensory retina radial incisions were...

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ILM Graft for Persistent MH After Primary Surgical Failure

Advantages: To describe a new surgical technique for macular hole closure using a patch of internal limiting membrane for persisting macular holes who have underwent pars plana vitrectomy with internal limiting membrane peeling. Methods: Six eyes of 6 patients presented to our hospital with persistent macular holes after having underwent pars plana vitrectomy, internal limiting membrane (ILM) peeling and gas tamponade. All patients...

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Inverted ILM Flap in MH with Poor Prognosis

Advantages: Inverted ILM flap technique can achieve good anatomical and functional success in large, long standing macular holes or in non idiopathic macular holes (as macular holes related to myopia, post vitrectomy for retinal detachment or post ocular trauma). Methods: Since July 2009 inverted ILM flap technique has been performed in macular hole with poor anatomical prognosis. ILM is incompletly peeled around the border of the hole...

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Are Macular Holes only a Vitreoretinal Interface Disease?

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Advantages: The aim of this study is to report on choroidal thickness and the morphology of the outer choroidoscleral boundary in Swept Source OCT in patients with full thickness macular holes before and after surgery. The secondary goal is to compare the morphology of the choroid with their fellow eyes and with healthy...

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The EVRS Macular Hole Study Results

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Spectral Domain OCT Analysis of MH Closure in Inverted Limiting Membrane Flap Technique

Advantages: To evaluate anatomical foveal microstructure and functional visual recovery associated with closure of idiopathic macular holes in the inverted internal limiting membrane (ILM) flap technique, and standard internal limiting membrane peeling technique. Methods: We describe the spectral domain OCT findings of 30 eyes that underwent surgery for macular hole closure (vitrectomy, ILM peeling with staining, air or gas tamponade, and...

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OCT Guided MH Form Factor as a Predictor of Surgical Outcome in Indocyanine Green Assisted ILM Peeling in the Treatment of Non-idiopathic Full Thickness MH

Poster Satya Pal Raji Background: To evaluate the role of Optical Coherence Tomography guided hole form factor (HFF) in the surgical outcome for non-idiopathic full thickness macular holes. Methods: In this prospective interventional study 27 eyes of 27 subjects (24 males (88.9%) and 3 females (11.1%)) with mean age of 28.57 +20.155 (SD 16.54) Non – Idiopathic full thickness macular holes and no other confounding factors were...

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Results of Idiopathic MH Surgeries

Advantages: To evaluate anatomical and functional results of idiopathic macular holes (IMH) surgeries. Methods: At the Ophthalmology department at Masaryk Hospital in Usti nad Labem we performed from January 1st 2011 until December 31st 2012 in total 36 surgeries due to IMH in 30 patients, while in 6 patients (16.7%) both eyes underwent surgery. In all patients we performed the 23G PPV with membrana limitans interna (MLI) peeling and a...

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MH After Intravitreal Ranibizumab Injection for DME

Poster Jaeryung Oh Purpose: To report a case of macular hole formed after intravitreal ranibizumab injection in diabetic macular edema. Case summary: A 76-year-old woman with a 30-year history of type 2 diabetes visited the clinic presenting with the complaint of decreased vision in her right eye. The best-corrected visual acuity of the right eye was 6/20, and 6/12 in the left eye. Intraocular pressure was 20 mmHg in her right eye and she...

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3 Cases of MH Following Intravitreal Injection with Ranibizumab

Poster Youngduk Kim Purpose: To report three cases of macular hole formation in patients who was administered intravitreal ranibizumab. Method: The first case was a 72-year-old man with age related macular degeneration and vitreomacular adhesion. The second case was a 76-year-old woman with subretinal haemorrhage and high PED. She was diagnosed with ARMD. The third case was 51-year-old woman with subretinal haemorrhage and high myopia....

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The Effect of Pathologic Myopia on the Result of MH Surgery

Poster Hakyoung Kim To evaluate the presence of pathologic myopia could affect the result of macular hole surgery.

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MH Combined with Ruptured Retinal Arterial Macro Aneurysm

Poster Young Joon Jo We report a case of macular hole with ruptured retinal arterial macro aneurysm. 84-year-old female had decreased vision 2 days ago. With fundus examination, dense preretinal and subretinal hemorrhage with ruptured retinal arterial macro aneurysm was detected, we planned vitrectomy for preretinal hemorrhage. After core vitrectomy, ICG assisted ILM peeling was done. After dense subILM hemorrhage was removed. MH was...

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Surgical Results in Bilateral Full-thickness MH After Laser-assisted in Situ Keratomileusis for Myopia

Poster 3 Miriam Garcia-Fernandez Advantages: To report the surgical results in a case of bilateral full-thickness macular hole (FTMH) after laser-assisted in situ keratomileusis (LASIK) for myopia. Methods: A 53-year-old Spanish woman who had undergone LASIK for the correction of myopia in her right and left eye (10 years ago) was referred to our department with a complaint of decreased visual acuity (VA) in both eyes. A complete ocular...

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Comparison of Success Rate According to the Duration of Prone Positioning After MH Surgery

Poster Young-suk Chang Purpose: To investigate the optimal duration of postoperative prone positioning after macular hole (MH) surgery by the comparison of the anatomical success rate. Methods: The clinical records were reviewed of all patients treated at Kim’s eye hospital between February 1, 2006 and February 28, 201 3, for an idiopathic macular hole. Coexisting ocular disease such as glaucoma, diabetic retinopathy, retinal vessel...

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Lens Status and Outcomes of Idiopathic MH Surgery

Poster 1 Osman Cekic To report the effect of lens status on anatomical and functional outcomes of idiopathic macular hole surgery.

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Spontaneous Closure of Stage IV Idiopathic MH and Late Reopening as a Lamellar MH

Poster 5 Joaquin Castro Navarro To report a case of spontaneous closure of stage IV full-thickness idiopathic macular hole (FTMH) and late reopening as a lamellar macular hole. Methods: A 67-year-old Spanish man was referred to our hospital with a complaint of decreased vision in his right eye and metamorphopsia for approximately 11 months. He did not report any trauma. A complete ocular examination, including, among others, determination...

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Can Retinitis Pigmentosa Influence MH Surgical Results?

Poster 2 Joaquin Castro Navarro Advantages: To report a case of unilateral recurrent macular hole in a patient affected by retinitis pigmentosa (RP). Methods: A 64-year-old woman, with the previous diagnosis of RP, was referred to our department with a complaint of central visual loss in her left eye (LE) for 12 months. A complete ocular exploration, including determination of Best Corrected Visual Acuity (BCVA) (decimal notation),...

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A Dramatic Complication After Idiopathic MH Surgery: Retinal Phototoxicity

Poster 1 Joaquin Castro Navarro Advantages: To report three cases of retinal phototoxicity caused by Xenon light during idiopathic macular hole surgery. Methods: Three eyes (3 patients), two females and one male with idiopathic macular hole, underwent three-port pars plana vitrectomy (Accurus, ALCON, Fort Worth, Tx, EUA) with internal limiting membrane peeling and fluid-gas exchange and fluid-gas exchange (C3F8) due to the presence of an...

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Surgical Treatment of Macular Hole Complicating Behçet’s Uveitis

Poster 3 Salim Ben Yahia Advantages: To report 2 cases of macular hole in patients with Behçet’s uveitis, and the results of surgical treatment. Methods: We report 2 young patients, diagnosed with Behçet’s uveitis, who developed a macular hole. Review of 2 patients’ charts, fluorescein angiography, optical coherence tomography, and results of surgical treatment. Effectiveness / Safety: The two patients were treated by...

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Differentiated Surgical Tactics for Idiopathic Macular Hole

Poster Ural Altynbaev An algorithm for a differentiated approach to the removal of the ILM and the choice of tamponade in surgery for stage 2 – 4 macular holes. Methods: The study included 110 patients with stage 2 – 4 idiopathic macular holes. All patients received a partial posterior vitrectomy with removal of the posterior hyaloid membrane. Then for patients with MH of up to 500 microns we aspirated fluid of bed of macular...

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Myopic Traction Maculopathy: Minimal 25 Gauge Vitrectomy and Pure Gas Bubble

Advantages: To describe our technique in highly myopic eyes affected by a form of posterior vitreous traction termed myopic traction maculopathy (MTM). Methods: A highly myopic phakic eye with MTM was operated with standard 25G vitrectomy and release of vitreoretinal traction with partially final fluid/gas exchange (pure gas bubble). The vitrectomy has been limited to posterior pole. The patient age was 45 years, refractive error was...

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Inverted Internal Limiting Membrane Flap Technique in Macular Hole Associated with Pathological Myopia

Advantages: To present the anatomic and functional results of vitrectomy with the “Inverted ILM Flap Technique” in myopic macular holes without retinal detachment. Methods: A prospective, interventional study of 19 myopic eyes with a spherical equivalent greater than -6D with macular holes in 18 consecutive patients. Pre- and postoperative evaluation of visual acuity and SD-OCT images was performed. The main outcome measure was...

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Outcomes of Macular Hole Surgery with Short-duration Positioning in Highly Myopic Eyes: A Case-control Study

Purpose: To evaluate the outcomes of macular hole (MH) surgery with 3 and 1 day postoperative positioning in highly myopic eyes and to compare these results with those from controls. Methods: The study design was a matched, case-control, retrospective chart review of consecutive eyes that underwent surgery for a MH between 2002 and 2010. Forty-seven eyes were included in the high myopic group and were matched for MH size and duration of...

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Failed Closure of Idiopathic Macular Hole: Causes & Management

Twenty-three eyes with idiopathic macular hole, that failed to close following vitrectomy, were divided into 2 groups: Group 1 (9 eyes) that where operated upon by the author himself, and Group 2 (14 eyes) that were operated by other surgeons and referred to the author because of non-closure. Eyes in Group 1 are known to have undergone posterior hyaloid and ILM peeling. All eyes underwent OCT. The macular hole was found open, enlarged with...

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Reoperations of Macular Holes Treated with Inverted ILM Flap Technique

Advantages: To present causes and surgical technique for reoperations in failed macular hole surgery in eyes previously operated with the inverted ILM flap technique. Methods: 11 eyes (6% of cases operated between 01.2008- 12.2011). During repeated surgery in all cases it was found that the inverted ILM flap reapproximated into its original position and did not close the macular hole. The ILM flap was put once again over the macular hole...

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Postoperatively Persistent Macular Holes: Visual Acuity Development with and Without Further Treatment

Postoperatively persistent macular holes after primary vitrectomy are a rare but regular finding. The strategy for further treatment of these cases is still under debate and ample treatment recommendations have been published. We analysed the outcome of untreated persistent macular holes as well as after gas injection or second vitrectomy with different endotamponades. Methods: In a retrospective case control study we analysed the...

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The Vitreous Gel as Reason of Failure in Macular Hole Surgery

From the review of the surgical failures that occurred in the last 3 years, it is suggested that a blob of hyaluronic acid resulting from the residual vitreous gel pooled inside the hole is a possible additional reason for failures in the surgery of macular holes. Vitrectomy mainly provides the removal of visible cortical vitreous composed of fibrils of collagen, but a variable amount of viscous hyaluronic acid often collects at the...

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Short-term Postoperative Non-supine Positioning vs Strict Face-down Positioning in Macular Hole Surgery

Purpose: The purpose of this study was to compare the efficacy of short-term non-supine positioning (NSP) and strict face-down positioning (FDP) in the repair of macular hole (MH). Methods: We retrospectively reviewed all MH repairs over a 27-month period (2008-2010). Inclusion criteria were idiopathic full thickness stage 2-4 MH treated by a single surgeon with 23-gauge pars plana vitrectomy, internal limiting membrane peeling and gas...

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Anatomical and Visual Outcomes of Macular Hole Surgery Using a Non-strict Posturing Regimen: 7-year Data

Purpose: To assess the anatomical and functional outcomes of macular hole surgery with pars plana vitrectomy (PPV), internal limiting membrane peeling and gas tamponade (SF6, C2F6, or C3F8) with a non-strict postoperative posturing regimen. Setting: Gloucestershire Hospitals NHS Trust, United Kingdom. Methods: Clinical and surgical data were prospectively entered into an electronic medical record (Medisoft, Leeds, UK). Data of...

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Macular Hole Surgery Without Face-down Positioning Using the Latest Vitreoretinal Techniques

Purpose: To evaluate the success rate of surgical repair of full-thickness macular holes without face-down positioning in a large series. Methods: A retrospective chart review of 81 consecutive patients with idiopathic full-thickness macular holes <750m in diameter were treated with standard surgical techniques by a single surgeon (PET). Surgical technique included 23-gauge pars plana vitrectomy, ICG-assisted peeling of the internal...

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Macular Hole Surgery: Does C3F8 Provide Better Anatomical and Functional Outcomes than SF6 and C2F6?

Purpose: To assess differences in anatomical and functional outcomes when using C2F6, SF6 or C3F8 gas tamponade in macular hole surgery with pars plana vitrectomy, internal limiting membrane peeling and a non-strict postoperative posturing regimen. Setting: Gloucestershire Hospitals NHS Trust, UK. Methods: Clinical and surgical data were prospectively entered into an electronic medical record (Medisoft, Leeds, UK). Data of consecutive...

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The Most Simple Technique of Gas Tamponade

Advantages:  This very fast technique requires a single injection of undiluted gas without the need of gas mixing. Methods:  After vitrectomy, ILM peeling and fluid/air exchange, the sclera is sutured, or, in sutureless surgery, the cannulas are removed, however, the globe is left slightly hypotonous. The level of hypotony is very easily assessed using a finger. Then, just an injection of 1.5 ml of SF6 is injected using a 30ga needle....

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Treatment of Full Thickness Macular Hole with ILM Peeling and Different Densities of Silicone Oil Tamponade

Advantages: A high macular hole closure rate is obtained, and late reopening of the hole is avoided. Methods: In a prospective randomized trial, 72 eyes of 71 patients underwent vitrectomy with ILM peeling after staining with ILM-Blue to treat full-thickness macular hole. Two treatment arms were used: either 2000 cs or 5000 cs silicone oil was used, which was removed after 3 months. During the second procedure, half of the eyes of each...

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Foveolar Surgery

Introduction: Development of micro invasive technologies expands the indications for surgical treatment of vitreomacular pathology to the point of preventive type of surgeries. Use of mercury light, allows for mechanical detachment of posterior hyaloid (PH) from the internal limiting membrane (ILM) without vitrectomy or staining in the eyes with adhesion of the PH, stage 1 macular hole (Gass classification system). Purpose: To evaluate...

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Advantages of ILM Blue in Macular Surgery

Internal Limiting membrane removal has been confronted by 2 obstacles for several years. These obstacles are circumvented nowadays by: Minimising the surgical trauma induced to the neurosensorial tissue, and the certainty to have removed the complete limiting membrane, from the papilla to the temporal raphe, and going until the vascular arcades. The use of a dye that was shown to be non-toxic allows a controllable, complete and...

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Comparative Evaluation of Indocyanine Green and Brilliant Blue Assisted Internal Limiting Membrane Peeling During Macular Hole Surgery

Purpose: To evaluate the anatomical closure rate and visual outcomes in patients undergoing pars plana vitrectomy with internal limiting membrane peeling with either indocyanine green staining and methylcellulose protection of the macular hole (group 1) or brilliant blue staining of the ILM (group 2). Methods: Non-controlled, retrospective case series of 187 eyes which underwent macular hole surgery between March 2007 and October 2009....

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Significance of PPV with ICG-Assisted ILM Peeling of Idiopathic Macular Holes Stage 4 with Poor Visual Acuity

Introduction: To compare the results of surgery for idiopathic macular hole stage 4 and reduced baseline visual acuity with natural outcome without surgery. Methods: Retrospective, nonrandomized, comparative study of consecutive case series with 19 eyes with idiopathic macular holes stage 4 and baseline visual acuity ≤0.2 (6/30) who underwent pars plana vitrectomy with ICG-stained ILM peeling to compare anatomical and visual outcome...

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Tano Scraper for ILM Peeling: Technique & Results

ILM peeling in idiopathic macular hole surgery is crucial to achieve high anatomical and functional success rate. ILM peeling may be done using special ILM forceps or Tano scraper. The purpose of this work is to describe the technique of using the Tanoscraper to start and peel the ILM in eyes with idiopathic macular holes (IMH). 35 eyes with idiopathic macular hole underwent vitrectomy, posterior hyaloid peeling, ILM peeling using the...

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Temporal Inverted Internal Limiting Membrane Flap for Macular Hole

Advantages: To present a new surgical technique, in which Internal Limiting membrane (ILM) is not removed only in the papillomacular bundle during vitrectomy for macular hole. Methods: This is a prospective study of 80 eyes of 80 patients. 40 eyes with macular holes were operated with the Inverted ILM technique (Group 1). 40 eyes were operated with modification of this technique, in which ILM was removed only on the temporal side of the...

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Reviewing the Main Steps in Macular Hole Surgery

Macular hole surgery has gone through many transformations as our understanding of the possible causes for the disease improved and the outcome of different techniques were compared. From complete posterior hyaloid detachment to face-down positioning, what seems to be really necessary and what is not? This paper tries to find answers to these questions through a rational approach sustained by...

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The Use of Complete Vitrectomy and ILM Peeling Using Infracyanine Dye + 0.8 ml Sf6 and 3 Days Gas Tamponade with Face-down Positioning in the Closure of Idiopathic Macular Hole: Our Experience

Methods: 23g valved trocars, no chandelier lights. Core vitrectomy, creation of PVD using Triamcinolone. Vitrectomy in medium periphery, ERM peeling without dyes, ILM peeling till vascular arcades using Infracyanine dye for 30 sec, confirmation of complete peeling using a second and eventual third dying with Infracyanine. Complete peripheral vitrectomy using Triamcinolone with particular attention at the sclerotomy sites. The peripheral...

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Unusual Evolution of Idiopathic Macular Holes: A Report of 8 Cases

Objective: Description of 8 idiopathic macular holes that had an unusual evolution. Introduction: Macular hole is the absence of macular retinal layers. Most idiopathic macular holes have a good outcome after surgery, which is vitrectomy, ILM peeling and gas tamponade. However, some unusual cases are still challenging the actual management of this pathology. Cases: (1) Surgical closure of macular hole with macular edema development...

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Foveal Tissue Elongation and Notching Sign After Macular Hole Surgery

Advantages: The authors had reported the phenomenon of foveal tissue elongation and its impact on metamorphopsia after macular hole (MH) surgery. Through this following study, we would like to present the clinical implications of notching sign in the parafoveal tissue after MH surgery. Methods: This study involved 35 eyes from 35 patients who underwent surgery for MH. Notching of tissue was defined as an abrupt alteration in the inner...

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Development of Full Thickness Macular Hole After Pars Plana Vitrectomy and Peeling of Epiretinal Membrane and Internal Limiting Membrane for Treatment of Idiopathic Lamellar Macular Hole

Advantages: To exhibit the characteristics of the idiopathic lamellar macular hole (ILMH) that evolves into full thickness macular hole (FTMH) after pars plana vitrectomy (PPV) and peeling of epiretinal membrane (ERM) and internal limiting membrane (ILM) and to discuss the indication and the timing of the surgical treatment. Methods: We report two cases of ILMH. Eyes underwent 23 gauge PPV and peeling of ERM and ILM with SF6 tamponade....

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Postoperative Macular Hole Closure Patterns and Its Relation with the Visual Outcome

To demonstrate the different postoperative macular hole closure patterns after macular hole surgery and their effect on the visual outcome.

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Interest of Reading Evaluation with an Eye Tracker in Idiopathic Macular Hole Before and After Surgical Treatment

Purpose: To evaluate the effect of idiopathic macular hole on eye movements during reading before and after macular hole surgery. Methods: Twelve patients with unilateral idiopathic full-thickness macular hole were included in this prospective case-control study. In the diseased eye, all patients underwent standard two-port pars plana vitrectomy with posterior hyaloid and ILM removal. Main outcome measures were the number and durations...

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Can Phacoemulsification Surgery Induce Changes in Patients with Idiopathic Partial Thickness Macular Holes?

Advantages: To analyze the morphologic changes (based on Optical Coherence Tomography: OCT examination) and the functional changes (based on determination of Best Corrected Visual Acuity: BCVA) in patients with the diagnosis of idiopathic partial-thickness macular holes (idiopathic Lamellar Macular Hole: LMH or Macular Pseudohole: MPH) who underwent routine cataract surgery. Methods: We prospectively analyzed 25 eyes of 23 patients with...

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Evolution of Idiopathic Partial Thickness Macular Holes. Therapeutic Implications

Advantages: To analyze the evolution of idiopathic partial thickness macular holes (lamellar macular holes (LMH) and macular pseudoholes (MPH)) in the long term, based on Optical Coherence Tomography (OCT) configuration and on Best Corrected Visual Acuity (BCVA) evolution, and, based on it, to determine the therapeutic implications. Methods: A prospective, observational study that includes patients with diagnosis of idiopathic LMH and/or...

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Cure for Idiopathic Macular Hole

For the treatment of idiopathic macular hole I use in my current practice this quite classical technique that I will describe. Results are good that is why I kindly recommend it.I use the 25 gauge Alcon Constellation platform to perform vitrectomy. I begin with core vitrectomy. After I complete it, even do a good shaving of the vitreous base. The next step is removing the posterior hyaloid. I sometimes use triamcinolone for a better...

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Macular Hole Surgery – Different Situations

The initial indications for macular hole surgery was only extensive retinal detachment caused by the hole. The modern technique of macular hole surgery with pars plana vitrectomy was started in early 1990s. The initial success rate of closure was about 60%. The surgery came a long way down the timeline to a closure rate of 80% to 90%. We use different vital stains to stain the internal limiting membrane. The viewing system improved a lot...

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Macular Hole Surgery: ILM Removal Without Dye

A 37 year old patient complaining of a blind spot in his central vision and visual acuity reduction following an accidental laser burn. On examination, he was found to have an extensive pre-retinal macular hemorrage. Following reabsorption of the hemorrage a large macular hole (700 microns) was found to be present with visual acuity reduced to 0,2. 25 gauge vitrectomy was performed. Kenalog assisted posterior hyaloid detachment and ILM...

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Full Thickness Macular Hole as a Complication of Idiopathic Parafoveal Telangiectasia: A Spectral Domain OCT Analysis

Full Thickness Macular Hole as a Complication of Idiopathic Parafoveal Telangiectasia A Spectral Domain OCT Analysis Laurence Lim Advantages: To document the macular changes in a patient with full thickness macular hole (FTMH) secondary to idiopathic parafoveal telangiectasia (IPFT) using spectral-domain optical coherence tomography (SD-OCT), and to propose possible mechanisms of FTMH formation. Methods: Fundus fluorescein angiography...

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A Comparison of Brilliant Blue G, Triamcinolone and Indocyanine Green Dyes to Assist ILM Peeling During Macular Hole Surgery

Purpose: To compare surgical outcomes with three dyes, brilliant blue G (BBG), triamcinolone (TA) and indocyanine green (ICG), used to facilitate internal limiting membrane peeling during macular hole surgery. Methods: This comparative, interventional cases series consisted of 30 eyes of 26 patients with senile idiopathic macular holes, who underwent 23 G vitrectomy with internal limiting membrane peeling. We compared the intraoperative...

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Enlarged ILM Peeling in Idiopatic Macular Hole Surgery: A Retrospective Study

Enlarged ILM Peeling in Idiopatic Macular Hole Surgery A Retrospective Study Claudia Bacalhau Objective: To evaluate the morphological and functional success of vitrectomy with enlarged internal limiting membrane peeling for full-thickness macular hole. Method: Retrospective study, including 18 patients with full-thickness macular hole that were submitted to vitrectomy with enlarged peeling of internal limiting membrane (until the...

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Cystoid ME After Macular Hole Surgical Closure

Cystoid ME After Macular Hole Surgical Closure Claudia Bacalhau Objective: Description of a clinical case with scientific interest. Introduction: Macular hole surgery has now very high successful morphological and functional rates, with few postoperative complications associated. We describe a case with development of clinically significant macular edema treated effectively. Case Study: 65 year-old patient with full thickness macular...

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A New Macular Hole Closure Technique

Surgery is the common therapy for the macular hole and it usually achieves a good anatomic and a mild functional success. The procedure follows well-defined steps: central and peripheral 23 gauge pars plana vitrectomy, internal limiting membrane removal, air or air+gas (SF6 or CH3F8) or silicon oil tamponade. But the surgeons relating to their experience differently perform every step. While there are many reviews upon internal limiting...

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Non-Full Thickness Macular Holes. A Closer Look!

Non-Full Thickness Macular Holes. A Closer Look!

Zofia Michalewska, Janusz Michalewski, Zofia Nawrocka, Jerzy Nawrocki (Lodz, Poland) Video documents a new theory of idiopathic non-full thickness macular holes based on spectral domain OCT (SD-OCT) observations and clinical appearance before and during surgery. It seems very probable that all these entities are caused by vitreoretinal traction, which produces local internal limiting membrane (ILM) defect in the fovea. These leads to...

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Eccentric Macular Holes After ILM Peeling for Macular Pucker: Clinical and Functional Findings?

M Nuñez, MP Mendivil, P Blasco, N Urrestarazu, L Ramos (Bilbao, Spain) Advantages: Parafoveal retinal holes after vitrectomy with peeling of the internal limiting membrane are an uncommon finding. The cause of this complication is still unknown. This case report presents a correlation between symptoms and retinal imaging. Case Report: A 50- year-old man with unremarkable medical and familiar history. The patient had been successfully...

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Phaco-vitrectomy with Internal Limiting Membrane Peeling for Full-thickness Macular Holes

Kubilhan Elmas, Özgür Bilen Basaran, Ali Altýnsoy (Ankara, Turkey) We reviewed the records of 17 consecutive patients (17 eyes) who underwent phacoemulsification and 23 gauge pars plana vitrectomy with ILM peeling in one session for repair of macular hole. The mean age of the patients was 66 (range 52 to 78) years. The mean duration of macular holes prior to surgery was 8 months. 12 holes closed, 5 remained opened. All patients except...

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Swelling of the Arcuate Retinal Nerve Fiber Layer (SANFL) After Internal Limiting Membrane Peeling for Idiopathic Macular Hole and Epiretinal Membrane Removal

Antonio Ciardella (Bologna, Italy) Advantages: To report a particular appearance of the fundus, occasionally seen after removal of the internal limiting membrane (ILM). Methods: 56 eyes of 56 consecutive patients with an epiretinal membrane and 38 eyes of 36 consecutive patients with idiopathic macular hole, who underwent pars plana vitrectomy and ILM peeling. All patients received a complete ophthalmic examination, infrared (IR) and...

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Non-Full Thickness Macular Holes. A Closer Look!

Zofia Michalewska, Janusz Michalewski, Zofia Nawrocka, Jerzy Nawrocki (Lodz, Poland) Video documents a new theory of idiopathic non-full thickness macular holes based on spectral domain OCT (SD-OCT) observations and clinical appearance before and during surgery. It seems very probable that all these entities are caused by vitreoretinal traction, which produces local internal limiting membrane (ILM) defect in the fovea. These leads to...

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Brilliant Peel Assisted Macular Hole Surgery

Yuksel Totan, Fatma Betul Aydogdu, Emre Guler (Ankara, Turkey) Advantages: To evaluate the surgical experiences with Brilliant blue G (BBG) staining of the inner limiting membrane (ILM) and the outcomes of BBG assisted macular hole surgery. Methods: In 10 patients with stage 3-4 idiopathic macular holes, BBG (Brilliant peel, Fluoron) was applied following complete posterior vitreous detachment on the macular surface under air conditions for...

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Congress – An unusual large tractional macular break

SYMPOSIUM:MACULA POT POURRI Moderator: Khaled El-Rakhawy Sunday, June 19, 2005 An unusual large tractional macular break Author: S. Ben Yahia, S. Jenzeri, B. Jelliti, S. Aouafi, M. Oueld El Hassen, R. Messaoud, A. Ladjimi, M. Khairallah Abstract : Purpose: To describe an unusual case of a large tractional macular break. Methods: Case report. Results: A 38-year-old healthy man presented with a sudden decrease of vision in his left...

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Congress – Pars Plana Vitrectomy wth ILM Peeling in Macular Hole Surgery

SYMPOSIUM: VITREOMACULAR INTERFACE VISUALIZATION / SURGICAL APPROACH Moderators: Claudio Azzolini, Etienne Bovey Tuesday, June 21, 2005 Pars plana vitrectomy (PPV) with ILM peeling in maculer hole surgery Author: Yaprak Banu Ünver, MD, Nur Acar, MD, Ziya Kapran, MD, Mehmet Cakır, MD, Zerrin Bayraktar, MD, Tugrul Altan, MD, Eylem Y. Pınarcı, MD Abstract : In stage 2, 3 and 4 maculer holes, anatomical and functional success is...

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Non-Full Thickness Fovea Defects, Either Idiopathic or Secondary to Vascular Diseases

http://www.evrs.eu/medias/2010/congress/Branch-Retinal-Vein-Occlusion-Central-Retinal-Vein-Occlusion.flv Zofia Michalewska, Jerzy Nawrocki (Lodz, Poland) Advantages: Spectral OCT (SD-OCT) allows visualizing differences between idiopathic non- full thickness macula defect, as lamellar macular hole or macular pseudo hole and non- full thickness macula defect secondary to vascular diseases, as vein occlusion, diabetic macular edema and...

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Macular Hole Hurgery with Inverted Internal Limiting Membrane Peeling Technique

Authors: Elmas Kubilhan, Bilen Özgür, Arsen Akýncý, Ersel Özkýlýç, Ali Altýnsoy, Ankara, Turkey Purpose: To study effect of inserting part of the internal limiting membrane to macular hole to form a bridge. Methods: In a prospective study the records of a consecutive series of 5 patients with full-thickness idiopathic macular holes operated with ICG-assisted ILM peeling by a single surgeon were analyzed. All patients underwent a...

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Massage on Large Macular Holes

http://www.evrs.eu/medias/2009/congress/Controversial-Techniques.flv Authors: George Pappas, Theoni Panagiotoglou, Dimitris Raptakis, Vasiliki Kounali, Paraskevi Drakou, Nikos Nikoletakis, Heraklion, Greece Advantages: To report the surgical outcome and the safety profile of massage around large macular holes in order to achieve closure. Methods: We have reviewed the notes of 12 patients who underwent pars plana vitrectomy (PPV) for large...

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Application of Retina Vacuum Massage for Intraoperative Closing of Macular Holes Stage 3-4

http://www.evrs.eu/medias/2009/congress/Controversial-Techniques.flv Authors: Ural R. Altynbayev, M.M. Bikbov, Ufa, Russia Advantages: The method allows achieving an intraoperative approximation of the edges in stage 3 – 4 macular holes, to prevent mechanical damage of photoreceptors and pigment epithelium and to improve anatomical and functional outcomes. Methods: The present study includes 12 patients with idiopathic macular hole...

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Spectral OCT History of Macular Hole

http://www.evrs.eu/medias/2009/videos/JerzyNawrocki_2_VP6_768K.flv Authors: Jerzy Nawrocki, Zofia Nawrocka, Janusz Michalewski, Zofia Michalewska, Lodz, Poland Advantages: To present the formation of macular hole and mechanism of its closure after vitrectomy. Methods: Both eyes of patients with macular holes were examined with spectral OCT (6 and 3um resolution). Effectiveness / Safety: Three different types of macular hole formation were...

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The Inverted ILM Flap Technique for Large Macular Holes

http://www.evrs.eu/medias/2009/videos/JerzyNawrocki_1_VP6_768K.flv Authors: Jerzy Nawrocki, Zofia Michalewska, Zofia Nawrocka, Janusz Michalewski, Lodz, Poland Advantages: To present a new idea of macular hole closure with the use of inverted ILM flap as a base membrane to improve the results in large, long-lasting macular hole. To evaluate postoperative results after vitrectomy in lamellar macular hole. Additionally to determine factors...

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The Inverted ILM Flap Technique for Large Macular Holes

The Inverted ILM Flap Technique for Large Macular Holes

Jerzy Nawrocki, Zofia Michalewska, Zofia Nawrocka, Janusz Michalewski, Lodz, Poland Advantages: To present a new idea of macular hole closure with the use of inverted ILM flap as a base membrane to improve the results in large, long-lasting macular hole. To evaluate postoperative results after vitrectomy in lamellar macular hole. Additionally to determine factors influencing postoperative outcome after vitrectomy for lamellar macular...

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Imaging Closure of Traumatic Macular Hole with Pneumatic Retionpexy by Optic Coherence Tomography

Eylem Yaman Pinarci Advantages: Methods: Effectiveness / Safety:

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