Abstract
Purpose To study the features in OCT-angiography and microperimetry in eyes with persistent full-thickness macular hole (FTMH) closed with the secondary plana vitrectomy (PPV) with autologous internal limiting membrane (ILM) plug. Methods Secondary PPV was performed with closing the persistent FTMH with ILM plug, C3F8 tamponade, and face-down positioning. Four patients were followed for 6 months with best corrected visual acuity (BCVA) measurement, SD-OCT and OCT-A, and microperimetry. The results were compared with the fellow eye; in two patients, it was the healthy eye, and in two remaining eyes, successfully closed FTMH after primary PPV. Results ILM flap was integrated in all cases with V-shape of closure, and atrophy was found in one case, with the largest diameter of FTMH. BCVA improved in two cases and remained the same in two cases. In OCT-A, the area of foveal avascular zone (FAZ) was larger, and foveal vessel density (FVDS) was smaller in eyes after secondary PPV in comparison to fellow eyes. In microperimetry, retinal sensitivity was lower in eyes after secondary PPV, and eccentric fixation was found in 2 of 4 patients. Conclusion Although the anatomical results of repeated surgeries of FTMH with ILM plug are favorable, visual function results may be limited. Secondary closure of FTMH with ILM plug may lead to atrophy, changes in the macular vasculature, and eccentric fixation. The trial is registered with NCT03701542.
Highlights
Pars plana vitrectomy (PPV) is the most effective treatment of full-thickness macular hole (FTMH) [1, 2]. e most untreated FTMHs will progress in size and grade and lead to increasing central visual loss [3]. e classical surgical procedure was first described by Kelly and Wendel in 1991 and consisted of PPV, peeling of epiretinal membranes at the macula, gas tamponade, and face-down positioning for 1 week after surgery [4]
Better surgical and functional results Journal of Ophthalmology are associated with the earlier stage of FTMH, better preoperative visual acuity (VA), shorter duration of symptoms, and younger patient age [7]. ere are some cases of persistent macular holes, defined as idiopathic macular holes that underwent vitrectomy but were never observed to close in the postoperative period. ere is the less common condition of reopened or recurrent macular hole, where the hole is observed to close after surgery but subsequently reopens [8]. e failure rate of primary surgery in FTMH is less than 10% [9]
PPV combined with internal limiting membrane (ILM) peeling has been a gold surgical standard in the treatment of FTMH for many years
Summary
Secondary Vitrectomy with Internal Limiting Membrane Plug due to Persistent Full-Thickness Macular Hole OCT-Angiography and Microperimetry Features: Case Series. To study the features in OCT-angiography and microperimetry in eyes with persistent full-thickness macular hole (FTMH) closed with the secondary plana vitrectomy (PPV) with autologous internal limiting membrane (ILM) plug. Secondary PPV was performed with closing the persistent FTMH with ILM plug, C3F8 tamponade, and face-down positioning. E results were compared with the fellow eye; in two patients, it was the healthy eye, and in two remaining eyes, successfully closed FTMH after primary PPV. Retinal sensitivity was lower in eyes after secondary PPV, and eccentric fixation was found in 2 of 4 patients. Secondary closure of FTMH with ILM plug may lead to atrophy, changes in the macular vasculature, and eccentric fixation. Secondary closure of FTMH with ILM plug may lead to atrophy, changes in the macular vasculature, and eccentric fixation. e trial is registered with NCT03701542
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
