Publication: Modificación de la técnica de flap invertido en la cirugía del agujero macular completo : estudio anatómico y funcional
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2022-10-18
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Universidad Complutense de Madrid
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Abstract
El agujero macular de espesor completo (AMC) es una discontinuidad anatómica a nivel foveal, que afecta a todas las capas de la retina, desde la membrana limitante interna (MLI) hasta el epitelio pigmentario de la retina (EPR), provocando la pérdida de agudeza visual (AV). Se trata de una patología poco frecuente, con una prevalencia 0,2-3,3 por 1000 habitantes. El agujero macular (AM) se origina debido a un síndrome de tracción vitreomacular y puede presentarse con diferentes estadios, definidos según el International Vitreomacular Traccion Study Group (IVTS). Esta clasificación se basa en el tamaño del agujero macular medido en su zona de mínima apertura. Los divide en pequeños (<250 micras),medianos (250-400 micras) y grandes (>400 micras). El diagnóstico es clínico y se confirma con pruebas de imagen, fundamentalmente con latomografía de coherencia óptica (OCT) estructural. El principal diagnóstico diferencial se hace con la membrana epirretiniana (MER) y con el agujero macular lamelar (AML).La clasificación del agujero macular según la OCT, diferencia los estadios 0, 1, 2, 3 y 4. El estadio 0 es un estadio preclínico; el estadio 1 es la tracción vítrea con alteración del perfil foveal; el estadio 2 presenta rotura del techo del agujero con adherencia del vítreo; el estadio 3 se trata de un agujero con el opérculo libre; y el estadio 4 va asociado, además, a un desprendimiento del vítreo posterior (DVP)...
Full-thickness macular hole is an anatomical discontinuity at the foveal level, affecting all retinal layers, from the internal limiting membrane to the retinal pigment epithelium, causing loss of visual acuity. It is a rare pathology, with a prevalence of 0.2-3.3 per 1000 population.The macular hole is caused by a vitreomacular traction syndrome and can present with different stages, defined according to the International Vitreomacular Traction Study Group. This classification is based on the size of the macular hole measured at its minimum opening zone. It divides them into small (<250 microns), medium (250-400microns) and large (>400 microns). The diagnosis is clinical and is confirmed with imaging tests, mainly structural optical coherence tomography. The main differential diagnosis is with epiretinal membrane and lamellar macular hole. The classification of macular hole according to optical coherence tomography differentiates stages 0, 1, 2, 3 and 4. Stage 0 is a preclinical stage; stage 1 isvitreous traction with alteration of the foveal profile; stage 2 presents rupture of the hole roof with vitreous adhesion; stage 3 is a hole with a free operculum; and stage 4 is also associated with posterior vitreous detachment. Without treatment, most macular holes progress with worsening visual acuity in weeksor months. Exceptionally, small holes may close spontaneously...
Full-thickness macular hole is an anatomical discontinuity at the foveal level, affecting all retinal layers, from the internal limiting membrane to the retinal pigment epithelium, causing loss of visual acuity. It is a rare pathology, with a prevalence of 0.2-3.3 per 1000 population.The macular hole is caused by a vitreomacular traction syndrome and can present with different stages, defined according to the International Vitreomacular Traction Study Group. This classification is based on the size of the macular hole measured at its minimum opening zone. It divides them into small (<250 microns), medium (250-400microns) and large (>400 microns). The diagnosis is clinical and is confirmed with imaging tests, mainly structural optical coherence tomography. The main differential diagnosis is with epiretinal membrane and lamellar macular hole. The classification of macular hole according to optical coherence tomography differentiates stages 0, 1, 2, 3 and 4. Stage 0 is a preclinical stage; stage 1 isvitreous traction with alteration of the foveal profile; stage 2 presents rupture of the hole roof with vitreous adhesion; stage 3 is a hole with a free operculum; and stage 4 is also associated with posterior vitreous detachment. Without treatment, most macular holes progress with worsening visual acuity in weeksor months. Exceptionally, small holes may close spontaneously...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 18-02-2022