Macular hole Delphi consensus statement (MHOST)

Filippo Confalonieri^{1

2}, Hanna Haave¹, Susanne Binder^{3

4}, Agnieszka Monika Bober⁵, Ragnheidur Bragadottir^{5

6}, Thomas Baerland⁵, Rowan Faber⁵, Vegard Forsaa^{7

8}, Julio J Gonzalez-Lopez^{9

10}, Andrea Govetto¹¹, Marta Haugstad⁵, Domagoj Ivastinovic¹², Neža Čokl Jenko¹³, Simona Delia Nicoară^{14

15}, Kuldar Kaljurand¹⁶, Igor Kozak¹⁷, Anders Kvanta¹⁸, Lyubomyr Lytvynchuk^{19

20}, Zofia Anna Nawrocka²¹, Sanja Petrovic Pajic²², Mojca Globočnik Petrovič²³, Liga Radecka²⁴, Matus Rehak^{25

26}, Mario R Romano², Andrii Ruban²⁷, Martynas Speckauskas²⁸, Ingar Stene-Johansen⁶, Zbynek Stranak^{29

30}, Angela Thaler¹³, Anna Sophie Aagaard Thein³¹, Ioannis Theocharis³², Zoran Tomic³², Xiaohe Yan³³, Muhamet Zekolli³⁴, Burim Zhuri³⁴, Ljubo Znaor^{35

36}, Beata Eva Petrovski³⁷, Miriam Kolko³⁸, Xhevat Lumi^{1

14}, Goran Petrovski^{1

35}

Affiliations

¹ Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway.
² Department of Biomedical Science, Humanitas University, Milan, Italy.
³ Department of Ophthalmology, Sigmund Freud University, Vienna, Austria.
⁴ Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA.
⁵ Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
⁶ Faculty of Medicine, University of Oslo, Oslo, Norway.
⁷ Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway.
⁸ Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.
⁹ Surgery Department, Universidad de Alcalá School of Medicine, Madrid, Spain.
¹⁰ Ophthalmology Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain.
¹¹ Ophthalmology Department, Fatebenefratelli and Ophthalmic Hospital, ASSt-Fatebenefratelli-Sacco, Milan, Italy.
¹² Department of Ophthalmology, Medical University Graz, Graz, Austria.
¹³ Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.
¹⁴ Department of Ophthalmology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
¹⁵ Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Romania.
¹⁶ Eye Clinic of Tartu University Clinics, Tartu, Estonia.
¹⁷ Moorfields Eye Hospital, Abu Dhabi, United Arab Emirates.
¹⁸ Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
¹⁹ Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg GmbH, Giessen, Germany.
²⁰ Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.
²¹ Ophthalmic Clinic "Jasne Blonia", Lodz, Poland.
²² Eye Hospital, Clinical Center of Serbia, Belgrade, Serbia.
²³ Eye Hospital University Medical Centre, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
²⁴ Riga East University Hospital, Riga, Latvia.
²⁵ Department of Ophthalmology, University of Leipzig, Leipzig, Germany.
²⁶ Department of Ophthalmology, Justus-Liebig University Giessen, Giessen, Germany.
²⁷ Center of Clinical Ophthalmology, Kyiv, Ukraine.
²⁸ Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
²⁹ Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
³⁰ Department of Ophthalmology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic.
³¹ Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
³² Department of Ophthalmology, University Hospital, Uppsala, Sweden.
³³ Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China.
³⁴ Laser Eye Center Kubati, Pristina, Kosovo.
³⁵ Department of Ophthalmology, University of Split School of Medicine, Split, Croatia.
³⁶ Department of Ophthalmology, University Hospital of Split, Split, Croatia.
³⁷ Faculty of Dentistry, University of Oslo, Oslo, Norway.
³⁸ Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark.

PMID: 37493073
DOI: 10.1111/aos.15682

Macular hole Delphi consensus statement (MHOST)

Filippo Confalonieri et al. Acta Ophthalmol. 2023 Nov.

. 2023 Nov;101(7):815-825.

doi: 10.1111/aos.15682. Epub 2023 May 10.

Authors

Affiliations

¹ Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway.
² Department of Biomedical Science, Humanitas University, Milan, Italy.
³ Department of Ophthalmology, Sigmund Freud University, Vienna, Austria.
⁴ Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA.
⁵ Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
⁶ Faculty of Medicine, University of Oslo, Oslo, Norway.
⁷ Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway.
⁸ Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.
⁹ Surgery Department, Universidad de Alcalá School of Medicine, Madrid, Spain.
¹⁰ Ophthalmology Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain.
¹¹ Ophthalmology Department, Fatebenefratelli and Ophthalmic Hospital, ASSt-Fatebenefratelli-Sacco, Milan, Italy.
¹² Department of Ophthalmology, Medical University Graz, Graz, Austria.
¹³ Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.
¹⁴ Department of Ophthalmology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
¹⁵ Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Romania.
¹⁶ Eye Clinic of Tartu University Clinics, Tartu, Estonia.
¹⁷ Moorfields Eye Hospital, Abu Dhabi, United Arab Emirates.
¹⁸ Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
¹⁹ Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg GmbH, Giessen, Germany.
²⁰ Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.
²¹ Ophthalmic Clinic "Jasne Blonia", Lodz, Poland.
²² Eye Hospital, Clinical Center of Serbia, Belgrade, Serbia.
²³ Eye Hospital University Medical Centre, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
²⁴ Riga East University Hospital, Riga, Latvia.
²⁵ Department of Ophthalmology, University of Leipzig, Leipzig, Germany.
²⁶ Department of Ophthalmology, Justus-Liebig University Giessen, Giessen, Germany.
²⁷ Center of Clinical Ophthalmology, Kyiv, Ukraine.
²⁸ Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
²⁹ Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
³⁰ Department of Ophthalmology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic.
³¹ Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
³² Department of Ophthalmology, University Hospital, Uppsala, Sweden.
³³ Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China.
³⁴ Laser Eye Center Kubati, Pristina, Kosovo.
³⁵ Department of Ophthalmology, University of Split School of Medicine, Split, Croatia.
³⁶ Department of Ophthalmology, University Hospital of Split, Split, Croatia.
³⁷ Faculty of Dentistry, University of Oslo, Oslo, Norway.
³⁸ Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark.

PMID: 37493073
DOI: 10.1111/aos.15682

Abstract

Purpose: To derive a Delphi method-based consensus for the surgical management of Full Thickness Macular Hole (FTMH) and Lamellar Macular Hole (LMH).

Methods: 37 expert VR surgeons from 21 mainly European countries participated in Delphi method-based questionnaire for diagnosis and treatment of FTMHs and LMHs.

Results: A total of 36 items were rated in round 1 by 37 participants, of which 10 items achieved consensus: intraoperative verification of PVD; clinical superiority of OCT-based FTMH classification; practical ineffectiveness of ocriplasmin; circular 360° ILM peeling for small macular holes; use of regular surgical technique for the size of the hole in concomitant retinal detachment; performing complete vitrectomy; SF6 gas as preferred tamponade; cataract surgery if crystalline lens is mildly/moderately opaque; removal of both ILM and LHEP in LMH surgery. In round 2, 18 items with moderate consensus (45-70% agreement) in round 1 were rated by 35 participants. Final consensus was reached in 35% of questions related to both diagnosis and surgical procedures.

Conclusions: This Delphi study provides valuable information about the consensus/disagreement on different scenarios encountered during FTMH and LMH management as a guide tosurgical decision-making. High rate of disagreement and/or variable approaches still exist for treating such relatively common conditions.

Keywords: DELPHI consensus statement; Full thickness macular hole (FTMH); Lamellar Macular Hole (LMH); surgical decision-making; surgical management.

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References

REFERENCES

1. Abdelkader, E. & Lois, N. (2008) Internal limiting membrane peeling in vitreo-retinal surgery. Survey of Ophthalmology, 53, 368-396.
1. Abdul-Kadir, M.-A. & Lim, L.T. (2021) Update on surgical management of complex macular holes: a review. International Journal of Retina and Vitreous, 7, 75.
1. Agrawal, R., Testi, I., Mahajan, S., Yuen, Y.S., Agarwal, A., Kon, O.M. et al. (2021) Collaborative ocular tuberculosis study consensus guidelines on the Management of Tubercular Uveitis-Report 1: guidelines for initiating Antitubercular therapy in tubercular choroiditis. Ophthalmology, 128, 266-276.
1. Albabtain, B., Mura, M., Schatz, P., Alsulaiman, S.M., Alsakran, W.A. & Semidey, V.A. (2021) Comparison of posterior hyaloid assessment using preoperative optical coherence tomography and intraoperative triamcinolone Acetonide staining during vitrectomy. Clinical Ophthalmology, 15, 3939-3945.
1. Brown, B.B. (1968) Delphi process: a methodology used for the elicitation of opinions of experts. undefined.

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Macular hole Delphi consensus statement (MHOST)

Affiliations

Macular hole Delphi consensus statement (MHOST)

Authors

Affiliations

Abstract

References

REFERENCES