Macular Hole: Imaging and Post Operative Positioning Studies

Since 1991 when Kelly and Wendel published the first case series of a surgical technique to repair macular holes, both the closure rates and functional outcomes have improved. The four novel studies presented in this thesis all have the subject of macular hole as a common theme running throughout. A comprehensive review of the pathophysiology, imaging and surgical reparative techniques is described in Chapter 1 which concludes with the results of a Cochrane review undertaken to determine the value of post-operative face down positioning. Chapter 2 focuses on a previously unreported method of imaging a macular hole using the Shadowgram overlay tool on the Topcon 3D – OCT 2000 (Topcon, Tokyo, Japan). This technique while offering no significant benefit over traditional linear OCT measurements may be of interest in other causes of macula pathology. Another aspect of macula imaging is explored in Chapter 3, which concentrates on assessing the reproducibility and reliability of the caliper tool on three different OCT devices. This original piece of work is the first of its kind to look in detail at the varies aspects of macular hole geometry. Chapters 4 and 5 offer an extensive explanation of the PIMS (positioning in macular hole study) trial. This NIHR funded trial is to date the largest multi-centre randomised controlled trial to determine whether advice to position face down improves the surgical success rate of closure of large (≥400 μm) macular holes

PIMS (Positioning In Macular hole Surgery) trial – a multicentre interventional comparative randomised controlled clinical trial comparing face-down positioning, with an inactive face-forward position on the outcome of surgery for large macular holes: study protocol for a randomised controlled trial

BACKGROUND: Idiopathic macular holes are an important cause of blindness. They have an annual incidence of 8 per 100,000 individuals, and prevalence of 0.2 to 3.3 per 1000 individuals with visual impairment. The condition occurs more frequently in adults aged 75 years or older. Macular holes can be repaired by surgery in which the causative tractional forces in the eye are released and a temporary bubble of gas is injected. To promote successful hole closure individuals may be advised to maintain a face-down position for up to 10 days following surgery. The aim of this study is to determine whether advice to position face-down improves the surgical success rate of closure of large (>400 μm) macular holes, and thereby reduces the need for further surgery. METHODS/DESIGN: This will be a multicentre interventional, comparative randomised controlled clinical trial comparing face-down positioning with face-forward positioning. At the conclusion of standardised surgery across all sites, participants still eligible for inclusion will be allocated randomly 1:1 to 1 of the 2 treatment arms stratified by site, using random permuted blocks of size 4 or 6 in equal proportions. We will recruit 192 participants having surgery for large macular holes (>400 μm); 96 in each of the 2 arms of the study. The primary objective is to determine the impact of face-down positioning on the likelihood of closure of large (≥400 μm) full-thickness macular holes following surgery. DISCUSSION: This will be the first multicentre randomised control trial to investigate the value of face-down positioning following macular hole standardised surgery. TRIAL REGISTRATION: UK CRN: 17966 (date of registration 26 November 2014)

Positioning In Macular hole Surgery (PIMS): statistical analysis plan for a randomised controlled trial

UK National Institute for Health Research (NIHR) through its Research for Patient Benefit scheme (grant number PB-PG-0213-30085)

Additional file 1: of Positioning In Macular hole Surgery (PIMS): statistical analysis plan for a randomised controlled trial

Templates for PIMS results tables. (PDF 391 kb

Karmen : L’art habile de la séduction. Karmen Geï, Canada / France / Sénégal 2001, 82 minutes

Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients