Elsevier

Ophthalmology

Volume 106, Issue 7, 1 July 1999, Pages 1392-1398
Ophthalmology

Macular hole surgery with internal-limiting membrane peeling and intravitreous air

Presented in part at the American Academy of Ophthalmology annual meeting, New Orleans, Louisiana, November 1998.
https://doi.org/10.1016/S0161-6420(99)00730-7Get rights and content

Abstract

Objective

To examine the results of macular hole surgery using pars plana vitrectomy, internal-limiting membrane peeling, and intravitreous air in a series of consecutive patients.

Design

A retrospective, interventional, noncomparative case series.

Patients

Fifty consecutive patients (58 eyes) with full-thickness macular holes.

Intervention

All eyes underwent a pars plana vitrectomy with internal-limiting membrane peeling and intravitreous air, and patients were asked to position face-down for only 4 days.

Main outcome measures

Status of macular holes, visual acuity, and associated findings and complications.

Results

All patients had postsurgical follow-up of 6 months or greater. Eight eyes (14%) presented with stage-2 macular holes, 48 eyes (83%) with stage-3 macular holes, and 2 eyes (3%) with stage-4 macular holes. Only 26 eyes (45%) had a macular epiretinal membrane seen before surgery. Fifty-three (91%) of the 58 macular holes were closed with 1 operation, and 55 (95%) had closure of the macular holes with subsequent operations. Five (9%) of 58 eyes had an initial visual acuity of 20/50 or better, and 31 eyes (53%) had a final visual acuity of 20/50 or better. Of the 45 eyes with symptoms of less than 6 months’ duration, 44 (98%) had macular holes that were closed with 1 operation and 27 (60%) had a final visual acuity of 20/50 or better. Of the 13 eyes with symptoms of 6 months’ duration or longer, 9 (69%) had macular holes that were closed with 1 operation and 4 (31%) had a final visual acuity of 20/50 or better. Complications attributed to the operation included retinal tears, retinal detachments, postoperative macular puckers, and macular light toxicity.

Conclusions

The anatomic and visual results in this series are good. The current technique is similar to that of conventional macular hole surgery except for the use of intravitreous air, internal-limiting membrane peeling in all eyes, and only 4 days of postoperative positioning. This study would suggest that peeling of the internal-limiting membrane is an important adjuvant for successful closure of macular holes.

Section snippets

Patients and methods

Fifty-five consecutive patients (64 eyes) with full-thickness macular holes underwent a PPV operation to repair the macular holes. Patients were referred to one of us (JOS) between October 1991 and July 1997 for the treatment of a macular hole. The initial surgery on all 64 eyes was performed by 1 surgeon (JOS). Eyes with traumatic macular holes were excluded. We performed a detailed medical and ocular history with a complete eye examination, including biomicroscopy. A chart review was

Results

Fifty-eight eyes of 50 consecutive patients underwent a PPV with internal-limiting membrane peeling and intravitreous air to repair full-thickness, idiopathic macular holes (stages 2–4). The mean age was 68 years (range, 42–79 years), and there were 33 women and 17 men. The mean follow-up was 696 days (range, 180–1869 days). Patients had symptoms for an average of 5.24 months (range, 0.5–48 months) before having the PPV surgery. Patient characteristics are presented in Table 1.

Eight (14%) of 58

Discussion

We report the results of 58 consecutive eyes with idiopathic, full-thickness macular holes that underwent PPV with internal-limiting membrane peeling and intravitreous air. All reported eyes had postsurgical follow-up of 6 months’ or greater duration, and the mean follow-up was 696 days.

Overall, the anatomic success rate was high with 53 (91%) of the 58 macular holes closed with 1 operation. For the eyes with macular holes of less than 6 months’ duration, 44 (98%) of 45 macular holes were

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