Abstract
Purpose: To determine prognostic factors, anatomic success rate and safety of sutureless pars plana vitrectomy and vitreous base removal associated to internal limiting membrane (ILM) peeling, C3F8 injection and 1-day facedown postoperative positioning to manage idiopathic macular holes (MHs) at 2 years follow-up. Methods: Forty-six eyes with an idiopathic MH underwent pars plana vitrectomy, ILM peeling after Brilliant Blue 0.05 mg/ml staining, and gas tamponade. Patients remained facedown for 1 day postoperatively. Follow-up included measurement of best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) at 1 and 7 days and 1, 6, 12, and 24 months postoperatively. If the MHs were not anatomically closed by 1 month, another procedure was performed. Results: Primary and final anatomical closure rate were 91.3% and 97.8%, respectively. Mean BCVA improvement (logarithm of the minimum angle of resolution, LogMAR) was 0.34. No late MH reopening occurred, no surgery-related or ocular dye-related complications developed. The BCVA was less likely to improve in MHs with longer symptomatic periods or larger internal diameters. Conclusion: Pars plana vitrectomy combined with vitreous base removal and ILM peeling using Brilliant Blue 0.05% associated to C3F8 injection and 1-day facedown postoperative positioning for idiopathic MHs is a safe surgical approach, achieving a MH closure rate of 91.3% after one procedure and 97.8% after a second one. Long symptoms duration and larger inner MH diameter are associated with poor BCVA.
Highlights
Idiopathic macular holes (MHs) are anatomic defects at the neurosensory central retina extending from the internal limiting layer (ILM) to the retinal pigment epithelium [1]
MHs are suspected when patients complain of visual impairment, central scotoma or metamorphopsia and confirmed by fundus examination and optical coherence tomography (OCT) [1,2]
We retrospectively evaluated 46 eyes of 46 consecutive patients between January 2012 to january 2013 with a diagnosis of MH and performed PPV with internal limiting membrane (ILM) peeling using a soluble formulation of Brilliant Blue 0.05 mg/ml (Ophthalmos, Sao Paulo, Brazil)
Summary
Idiopathic macular holes (MHs) are anatomic defects at the neurosensory central retina extending from the internal limiting layer (ILM) to the retinal pigment epithelium [1]. The original Gass classification [1,2] is still used widely in clinical practice, a new classification based on OCT findings was reported recently [3]. This classification considers the presence or absence of vitreomacular traction (VMT), size, and MH etiology. In this OCT-based anatomic classification system, MHs are defined as small when the minimal width is below 250 μm, medium from 250-400 μm, and large over 400 μm. MHs are classified as having or not having VMT and as primary or secondary forms
Sign-in/Register to view highlights & summary 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 callMore From: Journal of Clinical & Experimental Ophthalmology
Disclaimer: 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.
