Anatomical and functional results of pars plana vitrectomy+ ILM peeling+ gas endotamponade in patients with idiopathic stage 4 macular hole
Anatomical and functional results of pars plana vitrectomy+ ILM peeling+ gas endotamponade in patients with idiopathic stage 4 macular hole
Aim: To evaluate the anatomical and functional results in cases underwent 23-gauge pars plana vitrectomy (PPV) due to idiopathicstage 4 macular hole.Material and Methods: 17 eyes of 17 patients who underwent PPV due to idiopathic stage 4 macular hole between March 2013 andMarch 2016 at İnönü University Turgut Özal Medical Center Department of Ophthalmology were included in the study. The medicalrecords of the patients were retrospectively reviewed. Macular hole staging was performed according to biomicroscopic examinationand optical coherence tomography findings. Anatomical success was evaluated according to the condition of the macular hole afterthe surgery and functional success was evaluated according to the visual acuity.Results: 9 (53%) of the cases were females and 8 (47%) were males, the mean age was 66.6 ± 6.6 (55-81). PPV, internal limitingmembrane (ILM) peeling and gas tamponade were applied to all cases. The mean follow-up period was 13.9±9.7 (4-30) months. ILMpeeling was performed using trypan blue in three (17.6%) of the cases, brillant blue in 4 (23.5%) of the cases and membrane bluein 10 (58.8%) of the cases. Three cases (17.6%) were treated with C3F8 and 14 cases (82.3%) with SF6 gas tamponade. The meanpreoperatively best-corrected visual acuity (BCVA) was 0.08±0.06 (0.03-0.2) and the mean postoperatively BCVA was 0.16±0.15(0.03-0.5). Visual acuity did not change in two eyes (11.7%) and decreased in two eyes (11.7%). Macular hole had not closed in fourpatients (23.5%).Conclusion: 23 gauge PPV, ILM peeling and C3F8 or SF6 gas tamponade provides anatomical and functional success in the treatmentof idiopathic stage 4 macular hole.
___
- 1. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular
holes. Results a pilot study. Arch Ophthalmol 1991;109:654-
9.
- 2. Wendel RT, Patel AC, Kelly NE, et al. Vitreous surgery for
macular holes. Ophthalmol 1993;100:1671-6.
- 3. Gass JD. Reappraisal of biomicroscopic classification of
stages of development of a macular hole. Am J Ophthalmol
1995;119:752-9.
- 4. Gaudric A, Haouchine B, Massin P, et al. Macular hole
formation: new data provided by optical coherence
tomography. Arch Ophthalmol 1999;117:744-51.
- 5. Duker JS, Kaiser PK, Binder S, et al. The international
vitreomacular traction study group classification of
vitreomacular adhesion, traction, and macular hole.
Ophthalmol 2013;120:2611-9.
- 6. McCannel CA, Ensminger JL, Diehl NN, et al. Populationbased
incidence of macular holes. Ophthalmol
2009;116:1366-9.
- 7. Brooks HL Jr. Macular hole surgery with and without internal
limiting membrane peeling. Ophthalmol 2000;107:1939-48.
- 8. Johnson RN, Gass JD. Idiopathic macular holes.
Observations, stages of formation, and implications for
surgical intervention. Ophthalmol 1988;95:917-24.
- 9. Singh SR, Hariprasad SM, Narayanan R. Current management
of macular hole. Ophthalmic Surg Lasers Imaging Retina
2019;50:61-8.
- 10. Bardak Y, Çekiç O, Tığ UŞ, ve ark. Maküla deliği cerrahisi
sonuçlarımız. Ret-Vit 2007;15:171-5.
- 11. Al-Abdulla NA, Thompson JT, Sjaarda RN. Results of
macular hole surgery with and without epiretinal dissection
or internal limiting membrane removal. Ophthalmology
2004;111:142-9.
- 12. Park DW, Sipperley JO, Sneed SR, et al. Macular hole surgery
with internal-limiting membrane peeling and intravitreous
air. Ophthalmology 1999;106:1392-7.
- 13. Avcı R, Yıldız M, Şimşek Ş, ve ark. İdiopatik maküla
deliklerinin tedavisinde indosiyanin yeşili yardımı ile retina
iç limitan membranın soyulması. Ret-Vit 2005;13:13-7.
- 14. Öztürk M, Ün Y, Ergen A, İdiopatik maküla deliği cerrahisi
sonuçlarımız. Ret-Vit 2010;18:129-33.
- 15. Ovalı T, Erkul SÖ, Ovalı Ç, ve ark. İdiyopatik maküla deliği tedavisinde pars plana vitrektomi, internal limitan membran
soyulması ve bir günlük yatış pozisyonunun anatomik ve
fonksiyonel sonuçları. Ret-Vit 2009;17:238-44.
- 16. Yanyalı A, Dinçyıldız A, Çelik G, ve ark. İdiopatik maküla
deliğinde 25-Gauge transkonjonktival sütürsüz vitrektomi.
TOD Dergisi 2010;40:135-9.
- 17. Teke MY, Yılmaz MB, Şen E, ve ark. İdiyopatik maküla deliği
olan 167 hastanın tedavi sonuçları. Ret-Vit 2012;20:176-84.
- 18. Tognetto D, Grandin R, Sanguinetti G, et al. Internal limiting
membrane removal during macular hole surgery, results
of a multicenter retrospective study. Ophthalmology
2006;113:1401-10.
- 19. Ullrich S, Haritoglou C, Gass C, et al. Macular hole size as a
prognostic factor in macular hole surgery. Br J Ophthalmol
2002;86:390-3.
- 20. Kwok AK, Lai TY, Man-Chan W, et al.: Indocyanine green
assisted internal limiting membrane removal in stage 3 or 4
macular hole surgery. Br J Ophthalmol 2003;87:71-74.
- 21. Spiteri Cornish K, Lois N, Scott N, et al. Vitrectomy with
internal limiting membrane (ILM) peeling versus vitrectomy
with no peeling for idiopathic full-thickness macular hole
(FTMH). Cochrane Database Syst Rev 2013;6:CD009306.
- 22. Shukla D, Kalliath J, Neelakantan N, et al. A comparison of
brilliant blue G, trypan blue, and indocyanine green dyes to
assist internal limiting membrane peeling during macular
hole surgery. Retina 2011;31:2021-5.
- 23. Schumann RG, Gandorfer A, Priglinger SG, et al. Vital dyes for
macular surgery: a comparative electronmicroscopy study
of the internal limiting membrane. Retina 2009;29:669-76.
- 24. Ueno A, Hisatomi T, Enaida H, et al. Biocompatibility of
brilliant blue G in a rat model of subretinal injection. Retina
2007;27:499-504.
- 25. Andrew N, Chan WO, Tan M, et al. Modification of the inverted
internal limiting membrane flap technique for the treatment
of chronic and large macular holes. Retina 2016;36:834-7.
- 26. Michalewska Z, Michalewski J, Adelman RA, et al. Inverted
internal limiting membrane flap technique for large macular
holes. Ophthalmology 2010;117:2018-25.
- 27. Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of
inverted internal limiting membrane flap technique for the
treatment of macular hole in high myopia. Am J Ophthalmol
2013;156:125-31.e1.
- 28. Tornambe PE. Macular hole genesis: the hydration theory.
Retina 2003;23:421-4.
- 29. Elborgy ES, Starr MR, Kotowski JG, et al. No Face-down
positioning surgery for the repair of chronic idiopathic
macular holes. Retina 2018;6.
- 30. Eckardt C, Eckert T, Eckardt U, et al. Macular hole surgery with
air tamponade and optical coherence tomography based
duration of face-down positioning. Retina 2008;28:1087-96.
- 31. Huynh TH, Johnson MW. The behavior of surgically repaired
idiopathic macular holes in the setting of subsequent
cystoid macular edema. Retina 2007;27:759-63.
1313