Comparison of the use of internal limiting membrane flaps versus conventional ILM peeling on post-operative anatomical and visual outcomes in large macular holes

\ua9 The Author(s) 2024. Background: Idiopathic full-thickness macular hole (iFTMH) closure rates following conventional vitrectomy, gas tamponade and internal limiting membrane (ILM) peeling decrease when the minimum linear diameter (MLD) ≥ 500 microns. ILM flap creation has been proposed to improve closure in larger holes. This study evaluated the anatomical and functional impact of ILM flap introduction to routine practice in iFTMH ≥500 microns. Methods: Retrospective, interventional analysis of prospectively collected data of 191 eyes from consecutive surgeries for primary iFTMH ≥500 microns performed by two surgeons between June 2018 and June 2022, during which both surgeons replaced ILM peeling with ILM flap creation. Post-operative best-corrected visual acuity (BCVA) and anatomical closure were compared between Group 1 (ILM peel) and Group 2 (ILM flap) in an intention-to-treat analysis. Results: Rates of iFTMH closure were greater in the ILM flap group (77/80; 96.3%) than the ILM peel group (94/110; 85.5%) (OR = 4.37, 95% CI = 1.23–15.55, p = 0.023). A non-significant increase in post-operative BCVA improvement was observed in the ILM flap group (p = 0.084). There was no statistically significant difference in final BCVA (p = 0.83). Multivariate logistic regression found only MLD (OR = 0.993, 95% CI = 0.989–0.997, p = 0.001) and ILM flap group (OR = 5.795, 95% CI = 1.313–25.570, p = 0.020) predicted primary closure. Conclusion: ILM flap creation improves closure rates in larger holes and should be considered routinely in iFTMH ≥500 microns. Whether ILM flaps affect post-operative visual function remains uncertain

Prevalence of Cataract Surgery and Visual Outcomes in Indian Immigrants in Singapore: The Singapore Indian Eye Study

10.1371/journal.pone.0075584PLoS ONE810-POLN

Improving cataract services: better access, better outcomes, better value

Although highly effective treatment for cataract has been available around the world for several decades, it remains the leading cause of avoidable blindness. It is completely unacceptable that millions of people are deprived of their right to sight due to a condition that can be cured with a safe, fast, and cost-efficient procedur

Postretinal Detachment Retinal Displacement: How Best to Detect It?

PURPOSE: The reported incidence of postretinal detachment (RD) macular displacement varies markedly (14-72%). This may in part be due to the imaging modalities used. We compared the ability of 2 types of fundus autofluorescence (FAF) imaging modalities to detect this phenomenon. METHODS: Prospective study of 70 eyes with macula-involving RDs. 8 weeks postoperatively, patients underwent FAF imaging with 2 machines: a confocal scanning laser ophthalmoscope (cSLO) and a digital fundus camera (FC). Images were graded for the presence of hyperautofluorescent RPE (retinal pigment epithelium) ghost vessels, indicative of retinal displacement, by 2 masked, independent graders. RESULTS: In total, 87.1% of FC images were gradable versus 88.6% of cSLO images. Retinal displacement was detectable in 61.4% of FC images versus 52.8% of cSLO images. Vessel shift often appeared more autofluorescent on FC imaging, but choroidal vessels were more visible. Cohen's agreement between the imaging modalities was 0.50, rated as moderate agreement. For both imaging modalities, the inter- and intragrader agreement was substantial, representing good test-retest reliability. CONCLUSIONS: Detection of post-RD retinal displacement was similar between FC and cSLO FAF imaging, with only moderate agreement between both modalities

The efficacy of low vision devices for students in specialized schools for students who are blind in Kathmandu Valley, Nepal

In Nepal, children with low vision attend specialized schools for students who are totally blind and are treated as if they were totally blind. This study identified children with low vision and provided low vision devices to them. Of the 22% of the students in the school who had low vision, 78.5% benefited from the devices. Proper devices and counseling improved the quality of life of a significant number of these students. ©2008 AFB, All Rights Reserved

Receptor-targeted liposome-peptide-siRNA nanoparticles represent a novel and efficient therapeutic approach to prevent conjunctival fibrosis.

There is increasing evidence that the Myocardin-related transcription factor/Serum response factor (MRTF/SRF) pathway plays a key role in fibroblast activation and that knocking down MRTF can lead to reduced scarring and fibrosis. Here, we have developed a receptor-targeted liposome-peptide-siRNA nanoparticle as a non-viral delivery system for MRTF-B siRNA in conjunctival fibrosis. Using 50 nM siRNA, the MRTF-B gene was efficiently silenced by 76% and 72% with LYR and LER nanoparticles, respectively. The silencing efficiency was low when non-targeting peptides or siRNA alone or liposome-siRNA alone were used. LYR and LER nanoparticles also showed higher silencing efficiency than PEGylated LYR-P and LER-P nanoparticles. The nanoparticles were not cytotoxic using different liposomes, targeting peptides, and 50 nM siRNA. Three-dimensional fibroblast-populated collagen matrices were also used as a functional assay to measure contraction in vitro, and showed that MRTF-B LYR nanoparticles completely blocked matrix contraction after a single transfection treatment. In conclusion, this is the first study to develop and show that receptor-targeted liposome-peptide-siRNA nanoparticles represent an efficient and safe non-viral siRNA delivery system that could be used to prevent fibrosis after glaucoma filtration surgery and other contractile scarring conditions in the eye

The effect of sex and laterality on the phenotype of primary rhegmatogenous retinal detachment

Background: To assess the effect of sex and laterality on clinical features of primary rhegmatogenous retinal detachment (RRD). Method: This study is a retrospective analysis of data prospectively collected. We extracted data from two online datasets over a 7-year period of patients older than 16 years who had undergone surgery for primary RRD. Data on baseline characteristics were analyzed to compare males versus females, and right versus left eyes. Results: Of 8133 eyes analyzed, 4342 (53.4%) were right. The overall male predominance (63.7%) was more marked in the age range 50–69 years. Men were more commonly pseudophakic and presented more frequently with baseline posterior vitreous detachment (PVD). Female sex was significantly associated with baseline myopia, retinal holes as causative retinal break, and isolated inferior RD. Men had more frequent foveal involvement, greater RRD extent, greater numbers and larger sized retinal tears including dialysis and giant retinal tears. Regarding laterality, foveal involvement, larger retinal breaks, isolated temporal RD and temporal retinal breaks were more common in right eyes, whereas left eyes were more myopic at baseline and presented more frequently with isolated nasal RD and nasal retinal breaks. Conclusions: This study confirmed the predominance of male sex and right laterality in RRD. Sex and laterality were associated with multiple presenting features of RRD including extent, break distribution, number, size and type, as well as RD distribution.</p

The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence.

BACKGROUND: Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a two-year follow-up study of 1300 participants who had PLTR surgery, conducted by one of five TT nurse surgeons. None had previously undergone TT surgery. All participants received a detailed trachoma eye examination at baseline and 6, 12, 18 and 24 months post-operatively. The study investigated the recurrence rates, other complications and factors associated with recurrence. Recurrence occurred in 207/635 (32.6%) and 108/641 (16.9%) of participants with pre-operative major (>5 trichiatic lashes) and minor (5 lashes (major recurrence). Recurrence was greatest in the first six months after surgery: 172 cases (55%) occurring in this period. Recurrence was associated with major TT pre-operatively (OR 2.39, 95% CI 1.83-3.11), pre-operative entropic lashes compared to misdirected/metaplastic lashes (OR 1.99, 95% CI 1.23-3.20), age over 40 years (OR 1.59, 95% CI 1.14-2.20) and specific surgeons (surgeon recurrence risk range: 18%-53%). Granuloma occurred in 69 (5.7%) and notching in 156 (13.0%). CONCLUSIONS/SIGNIFICANCE: Risk of recurrence is high despite high volume, highly trained surgeons. However, the vast majority are minor recurrences, which may not have significant corneal or visual consequences. Inter-surgeon variation in recurrence is concerning; surgical technique, training and immediate post-operative lid position require further investigation

Internal Limiting Membrane Flaps in Macular Hole Surgery: A Systematic Review and Individual Participant Data Meta-analysis

\ua9 2025 American Academy of OphthalmologyTopic: To compare anatomic and visual outcomes of internal limiting membrane (ILM) flaps versus peeling in macular hole surgery, considering hole size, symptom duration, and different flap types. Clinical Relevance: The benefit of ILM flaps over standard ILM peeling in idiopathic full-thickness macular holes (iFTMHs) remains unclear. Methods: Registered systematic review and individual participant data (IPD) meta-analysis of randomized controlled trials comparing conventional ILM peeling with ILM flaps in adults undergoing primary iFTMH surgery (CRD42023494971). No exclusions based on hole size, symptom duration, or perioperative choices. Searches in MEDLINE, Embase, Cochrane Library, and trial registries. Critical outcomes were hole closure and postoperative visual acuity at 6 months or nearest time point. Regression models adjusted for age, sex, hole size, lens status, and preoperative visual acuity, allowing for nonlinear effects. Evidence was appraised with Cochrane Risk of Bias, Grading of Recommendations Assessment, Development, and Evaluations, and the Instrument to assess the Credibility of Effect Modification in Analyses. Subgroup analyses considered hole size, symptom duration, flap subtypes, tamponade choice, and risk-of-bias. Results: Thirteen trials provided IPD for 792 eyes. Most (68.3%) had minimum linear diameter ≥500 μm, with limited representation of holes &lt;400 and ≥900 μm. The adjusted odds ratio (OR) for primary closure with ILM flap versus peeling was 4.80 (95% confidence interval, 2.77–8.30; P &lt; 0.001), with a relative risk of 1.26 (1.20–1.30) (Grading of Recommendations Assessment, Development, and Evaluations: moderate-certainty), and a number needed to treat of 6. Compared with peeling, the ILM flap group showed better postoperative visual acuity at 3 to 6 months, with a mean difference (MD) of −0.14 logarithm of the minimum angle of resolution (−0.18 to −0.09; P &lt; 0.001), about 7 letters ETDRS (Grading of Recommendations Assessment, Development, and Evaluations: moderate-certainty). Internal limiting membrane flaps were likely more beneficial for holes ≥500 μm (OR for closure: 3.14–9.64, P &lt; 0.001; MD in vision: −0.23 to −0.13, P &lt; 0.001). Nonlinear analyses suggested probable benefits across a broader range of hole sizes (Instrument to assess the Credibility of Effect Modification in Analyses: moderate-confidence). Results were consistent across risk-of-bias assessments, with no significant differences between ILM flap techniques. Conclusion: Internal limiting membrane flaps likely improve closure and visual recovery compared with peeling alone in iFTMH, with greater effects likely in holes &gt;500 μm. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article