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Vitrectomy combined with lens capsule flap transplantation in the treatment of high myopia macular hole retinal detachment: study protocol for a prospective randomised controlled trial
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Other responses

  • Published on:
    Autologous anterior lens capsule transplantation to treat refractory macular holes : Issues for challenging cases
    • Thibaud GARCIN, Ophthalmologic Surgeon MD, PhD, Assistant Professor Hospital Lariboisiere, Paris, FRANCE ; University Hospital of Saint Etienne, Saint-Etienne, FRANCE

    To close complex MHs, different options have been described in different small series which pioneered various adjuvants : mainly fresh or lyophilized human amniotic membrane (AM) transplantation either transplanted into the subretinal space1-3 either put in epiretinal position4,5, autologous or allogenic lens capsular (ALC) flap transplantation inside6 or over7 the MH, autologous neurosensory retinal (ANR) free flap transplantation8.

    We would like to discuss several points with the authors, referring to additional references:
    1/ First, the cut off of 400 μm chosen to include high myopia macular hole retinal detachment (HMMHRD), is questionable as most of the time HMMHRD are associated with extra-large macular holes (MH) (>>400 μm) with a various amount of sub retinal fluid (SRF). The authors could have chosen another cut off to increase extrapolation of their future findings, according to the trends of new classifications. Based on the closure rate and the functional results, some authors proposed to update the International Vitreomacular Traction Study group9, as Steel et al.10 with MH>500 μm, or Ch’ng et al.11 with MH>650 μm, or Rezende et al.12 with MH>800 μm, and so use new surgical techniques such as ILM or ALC flap or ANR transplantation : why do not choose the cut off of 500 or 650 μm to include HMMHRD patients for the proposed trial? For the sample size calculation, the closure rate chosen in the control group (65%) is questionable rega...

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    Conflict of Interest:
    None declared.