Abstract
PurposeTo compare the results of 20, 23, 25 gauge pars plana vitrectomy (PPV) with two different gas tamponades for idiopathic macular hole (MH) in a multi-surgeon vitroretinal practice.MethodsIn this comparative, retrospective, interventional case series, the medical charts of 142 eyes/130 patients were reviewed. Patients who matched our inclusion criteria: eye with stage 2, 3, or 4 MH that underwent 20, 23, or 25 gauge PPV, internal limiting membrane (ILM) peeling, and fluid-gas exchange from January, 2005 to May, 2012 and had at least 6 months follow-up. The best current corrected visual acuity (VA) and anatomical status of the MH were assessed by optical coherent tomography (OCT) at 6 months, 1 year, and 2 years after vitrectomy.ResultsThe MH closed successfully after primary vitrectomy in 86.5 % (20 gauge), 96.4 % (23 gauge), and 92 % (25 gauge). Preoperative VA median were 20\\126 (20 gauge), 20\\100 (23 gauge), and 20\\80 (25 gauge). At 6 months and 2 years postoperative VA did not differ significantly between the 3 groups (p = 0.570, and 0.054 respectively). However, at 12 months postoperative VA median 20\\60 (20 gauge), 20\\69 (23 gauge), and 20\\40 (25 gauge) differ significantly (p = 0.005) likely due to cataract changes. The final median postoperative VA (at 2 years) in 25 gauge PPV group was 20/40 which was better than final visual outcomes for 20, and 23 gauge PPV groups (20/50, and 20/55 respectively). The different was not a statistically significant. MH closed successfully in 96 % (C3F8), and 88.1 % (SF6) (p = 0.063). Preoperative median VA was 20/100 in both groups of gas. At 6 months, 1 year, and 2 years postoperative median VAs did not differ significant between the 2 groups (p = 0.076, 0.343, and 0.309 respectively). MH closed successfully in (96.9 %) 12-14 % C3F8, and (95.3 %) 15-16 % C3F8 (p = 0.611). MH closed in (82.1 %) 18-20 % SF6, and (96.4 %) 22-26 % SF6 (p=0.053).ConclusionBased on the results of this study, 20, 23, and 25 gauge of PPV have similar MH closure rates and VA outcomes. SF6 at 22-26 % or C3F8 at 12-14 % achieved maximum closure rates.
Highlights
Idiopathic macular hole (MH) is relatively common cause of visual loss, with women having about double the rate of men
Surgery comprises a three-port Pars plana vitrectomy (PPV) combined with induction of a posterior hyaloid detachment if not already present, removal of the posterior cortical vitreous, and intraocular tamponade with long-acting gas followed by a period of face-down positioning
Indocyanine green (ICG) dye used during surgery in 137 eyes (96.5 %), Methyline blue in 1 eye (0.7 %), no dye used in 2 eyes (1.4 %), and Triesence used in 2 eyes (1.4 %)
Summary
Idiopathic macular hole (MH) is relatively common cause of visual loss, with women having about double the rate of men. Other advances have been internal limiting membrane (ILM) peeling with or without dye to further relieve traction on the hole [9], and the use of adjuncts such as autologous serum and fibrin, transforming growth factor beta, platelets, and thrombin to aid in the wound healing process [2]. Despite of all these developments, there has been little research comparing functional and anatomical efficacy of three gauge PPV systems when used for treating MH.
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