Naoto Sato, MD
Suzuki Eye Group, Tokyo, Japan
The Macular Surgery session kicked off Saturday morning. The session was moderated by Drs. Hitoshi Takagi, Takayuki Baba, and Cheng-Kuo Cheng.
First, Dr. Chi-Chun Lai of Chang Gung Memorial Hospital, Taiwan, shared his technique for managing recurrent large macular holes in highly myopic eyes. Dr. Lai described using the anterior lens capsule and amniotic membranes to treat refractory macular holes. The first case he presented was a recurrent macular hole that was treated twice with autologous retinal transplant, but the hole remained open. During the final vitrectomy with cataract surgery, the excised anterior capsule was saved during capsulorhexis and implanted in the macular hole using ILM forceps under perfluorocarbon liquid, followed by fluid-air exchange. The macular hole successfully closed with this technique.
He then showed a detachment with a large macular hole which closed with anterior capsule placement. He presented two similar cases that closed with amniotic membrane, which he indicated is especially useful when treating larger macular holes. He noted that dehydrated amniotic membrane is preferred because of its transparency.
Next, Dr. Takashi Koto of Kyorin University evaluated different forceps in terms of grip, pressure and friction.
The study compared the characteristics of three ILM forceps (Alcon Sharkskin forceps, Alcon Grieshaber forceps, Katalyst Hassan forceps) using a surgical simulator. Grip force was strongest in Grieshaber forceps, followed by Sharkskin forceps, and finally Katalyst forceps. In contrast, pressure against the retina was strongest in Katalyst forceps, followed by Grieshaber forceps, and finally Sharkskin. Kinetic friction was strongest in the Sharkskin forceps, followed by Grieshaber forceps, and finally Katalyst forceps.
Dr. Takayuki Baba of Chiba University then presented the correlation between retinal sensitivity and structural OCT. First, his group examined the correlation between microperimetry findings and OCT findings in highly myopic eyes. The retinal sensitivity in the area of patchy atrophy was impaired, corresponding to OCT findings of EZ disruption and total thickness of the retina. Next, they examined epiretinal membranes. Although the retinal sensitivity was corelated with EZ disruption, total retinal thickness was not correlated with retinal sensitivity. Thickness of ganglion cell complex layer was negatively correlated with retinal sensitivity.
The last speaker, Dr. Yuki Morizane of Okayama University, proposed a new classification of lamellar macular hole (LMH). In 2020, three clinical entities were proposed for LMH: LMH, epiretinal membrane foveoschisis (ERM-FS), and macular pseudohole (MPH). Their work focused on the method of classifying the overlapping type of each group. These types were referred to as “mixed type” in their presentation, observed at a rate of 34.1%.
They proposed three new clinical entities: ERM-FS/MPH group, LMH-related mixed type, and True LMH. They investigated visual acuity and M-chart scores among each group. While visual acuity was worse in the True LMH group, metamorphopsia was not significantly different among the groups. Epiretinal proliferation was present in 6.8% of ERM-FS/MPH cases, 42.5% of mixed type cases, and 88.4% of True LMH cases.