To evaluate the success of a mini-invasive technique for operation of idiopathic macular hole (IMH).
Methods
We retrospectively examined 29 patients (30 eyes) in whom 25-G pars plana vitrectomy (PPV), peeling of the inner limiting membrane (ILM), and application of air tamponade were performed. The group of the patients included 7 males and 22 females (76%), age range 57-79 years (median 70). The follow-up period was 3-47 months (median 17).
Results
Pars plana vitrectomy was indicated only in the stages of full-thickness macular hole. Prior to operation, 13 eyes (43%) were in stage 2, 15 eyes (50%) in stage 3, and 2 eyes (7%) in stage 4. The IMH healed in 28 eyes after operation. Persistence of IMH occurred in 2 eyes (7%). After subsequent reoperation with extension of the peeling zone of the ILM and gas tamponade (with 10% C3F8), these macular holes also healed (100%). Prior to carrying out PPV, best-corrected visual acuity (BCVA) ranged between 20/40 and 20/500 (median 20/125). At the end of the follow-up period, BCVA was improved to 20/40 (median). The change in the final BCVA compared to the initial visual acuity was statistically significant (p = 0.008; Wilcoxon).
Conclusions
The 25-G PPV with peeling of the ILM and air tamponade is an effective technique and presents no increased risks in comparison with routine procedures. The main benefit of the intervention is its good tolerance by the patient, particularly with respect to painfulness and postoperative irritation.
KnappHUeber isolirte zerreissugen der aderhaut in folge von traumen auf dem augapfel.Arch Augenheilkd1869;16–29
2.
KuhntHUeber eine eigentumliche veranderung der netzhaut ad maculam (retinitis atrophicans sive rareficans centralis).Z Augenheilkd1900;105 (3):45–49
3.
JohnsonRNGassJDIdiopathic macular holes. Observations, stages of formation, and implications for surgical intervention.Ophthalmology1988;95 (7):917–924
4.
GassJDIdiopathic senile macular hole. Its early stages and pathogenesis.Arch Ophthalmol1988;106 (5):629–639
5.
DukerJSKaiserPKBinderS et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole.Ophthalmology2013;120 (12):2611–2619
6.
KellyNEWendelRTVitreous surgery for idiopathic macular holes. Results of a pilot study.Arch Ophthalmol1991;109 (5):654–659
7.
KarelIKalvodováBDotrelováD et al. (Vitrectomy and autologous thrombocyte concentrate in the treatment of idiopathic macular holes).Cesk Slov Oftalmol1999;55 (4):191–202
8.
VeithMStraňákZPenčákMStudenýP(Surgical Treatment of the Idiopathic Macular Hole by Means of 25-Gauge Pars Plana Vitrectomy with the Peeling of the Internal Limiting Membrane Assisted by Brilliant Blue and Gas Tamponade).Cesk Slov Oftalmol2015;71 (3):170–174
9.
SharmaPJuhnAHoustonSK et al. Efficacy of intravitreal ocriplasmin on vitreomacular traction and full-thickness macular holes.Am J Ophthalmol2015;159 (5):861–7.e2
10.
RizzoSGenovesi-EbertFMurriS et al. 25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study.Graefes Arch Clin Exp Ophthalmol2006;244 (4):472–479
11.
OkamotoFOkamotoCSakataN et al. Changes in corneal topography after 25-gauge transconjunctival sutureless vitrectomy versus after 20-gauge standard vitrectomy.Ophthalmology2007;114 (12):2138–2141
12.
SínMSínováIChrapekO et al. The effect of pars plan vitrectomy on oxygen saturation in retinal vessels—a pilot study.Acta Ophthalmol2014;92 (4):328–331
13.
JacksonTLDonachiePHSparrowJMJohnstonRLUnited Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 2, macular hole.Ophthalmology2013;120 (3):629–634
14.
RosaRHJrGlaserBMde la CruzZGreenWRClinicopathologic correlation of an untreated macular hole and a macular hole treated by vitrectomy, transforming growth factor-beta 2, and gas tamponade.Am J Ophthalmol1996;122 (6):853–863
15.
SatoHKawasakiRYamashitaHObservation of idiopathic full-thickness macular hole closure in early postoperative period as evaluated by optical coherence tomography.Am J Ophthalmol2003;136 (1):185–187
16.
GuillaubeyAMalvitteLLafontainePO et al. Comparison of face-down and seated position after idiopathic macular hole surgery: a randomized clinical trial.Am J Ophthalmol2008;146 (1):128–134
17.
IpMSBakerBJDukerJS et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography.Arch Ophthalmol2002;120 (1):29–35
18.
PrivatETadayoniRGaucherDHaouchineBMassinPGaudricAResidual defect in the foveal photoreceptor layer detected by optical coherence tomography in eyes with spontaneously closed macular holes.Am J Ophthalmol2007;143 (5):814–819
19.
SheidowTGBlinderKJHolekampN et al. Outcome results in macular hole surgery: an evaluation of internal limiting membrane peeling with and without indocyanine green.Ophthalmology2003;110 (9):1697–1701
20.
LoisNBurrJNorrieJet al;Full-thickness Macular Hole and Internal Limiting Membrane Peeling Study (FILMS) Group. Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomized controlled trial.Invest Ophthalmol Vis Sci2011;52 (3):1586–1592
21.
TadayoniRGaudricAHaouchineBMassinPRelationship between macular hole size and the potential benefit of internal limiting membrane peeling.Br J Ophthalmol2006;90 (10):1239–1241
22.
TadayoniRCreuzot-GarcherCKorobelnikJ-F et al. Internal Limiting Membrane Peeling for Large Macular Holes: A Randomized, Multicentric, and Controlled Clinical Trial.Invest Ophthalmol Vis Sci2009;505206
23.
GrisantiSSzurmanPTatarO et al. Histopathological analysis in experimental macular surgery with trypan blue.Br J Ophthalmol2004;88 (9):1206–1208
24.
TornambePEPolinerLSGroteKMacular hole surgery without face-down positioning.A pilot study. Retina1997;17 (3):179–185
25.
HeFDongFYuWDaiRRecovery of photoreceptor layer on spectral-domain optical coherence tomography after vitreous surgery combined with air tamponade in chronic idiopathic macular hole.Ophthalmic Surg Lasers Imaging Retina2015;46 (1):44–48
26.
HaritoglouCEhrtOGassCAKristinNKampikAParacentral scotomata: a new finding after vitrectomy for idiopathic macular hole.Br J Ophthalmol2001;85 (2):231–233
27.
Tarita-NistorLGonzálezEGMandelcornMSLillakasLSteinbachMJFixation stability, fixation location, and visual acuity after successful macular hole surgery.Invest Ophthalmol Vis Sci2009;50 (1):84–89
28.
ScottIUMoraczewskiALSmiddyWEFlynnHWJrFeuerWJLong-term anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery.Am J Ophthalmol2003;135 (5):633–640
29.
MuselierADugasBBurelleX et al. Macular hole surgery and cataract extraction: combined vs consecutive surgery.Am J Ophthalmol2010;150 (3):387–391
30.
RizzoSGenovesi-EbertFMurriS et al. 25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study.Graefes Arch Clin Exp Ophthalmol2006;244 (4):472–479
31.
WickhamLBunceCKwanASBainbridgeJAylwardGWA pilot randomised controlled trial comparing the post-operative pain experience following vitrectomy with a 20-gauge system and the 25-gauge transconjunctival system.Br J Ophthalmol2010;94 (1):36–40
