Transkonjunktivale nahtlose Pars-plana-Vitrektomie und Brilliant-Blau-G-assistiertes ILM-Peeling bei Patienten mit Makulaforamen

 

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Zusammenfassung

Hintergrund: Ziel der Studie war es, die Visusergebnisse und den anatomischen Erfolg mittels hochauflösendem OCT nach transkonjunktivaler nahtloser 23-Gauge Pars-plana-Vitrektomie und Brilliant-Peel-(BP-)assistiertem ILM-Peeling bei Patienten mit Makulaforamen zu erfassen.

Methode: In einer retrospektiven Studie bei 41 Augen von 41 konsekutiven Patienten mit Makulaforamen wurde eine standardisierte 23-G Pars-plana-Vitrektomie mit BP-assistiertem ILM-Peeling und Gastamponade durchgeführt. Bei allen Patienten wurde präoperativ der bestkorrigierte Visus bestimmt und mittels hochauflösendem Spectral Domain OCT (SD-OCT; Spectralis; Heidelberg Engineering) der maximale Durchmesser, die Basis und die Höhe des Makulaforamens, sowie intraretinale Veränderungen erfasst. Postoperativ wurde der bestkorrigierte Visus nach 1, 3, and 6 Monaten und die Verschlussrate bestimmt. Daneben wurde die mikrostrukturelle Integrität des Photorezeptor-Inner/Outer-Segments (IS/OS) im SD-OCT erfasst und mit dem Visusergebnis nach Makulaforamenchirurgie korreliert.

Ergebnisse: Der mittlere Ausgangsvisus betrug 0,2 (0,77 logMAR). Er verbesserte sich nach 1, 3 und 6 Monaten signifikant auf 0,4 (0,46 logMAR), 0,44 (0,41 logMAR) und 0,58 (0,28 logMAR). Die Verschlussrate der Makulaforamina betrug 95,1 %. Die Integrität des IS/OS-Segments wurde semiquantitativ bestimmt und zeigte eine positive Korrelation zum bestkorrigierten Visus.

Schlussfolgerung: Die transkonjunktivale nahtlose Pars-plana-Vitrektomie mit Brilliant-Peel- (BP-)assistiertem ILM-Peeling bei Patienten mit Makulaforamen ist eine sehr sichere Operationsmethode, die zu guten funktionellen und anatomischen Ergebnissen führt. Die mikrostrukturelle Integrität des IS/OS-Segments der Netzhaut lässt sich mittels SD-OCT gut beurteilen. Sie ist ein wichtiger prädiktiver Parameter für die Visusentwicklung nach Makulaforamenchirurgie.

Abstract

Purpose: The aim of this study was to evaluate the visual and anatomic outcome after 23-gauge transconjunctival sutureless pars plana vitrectomy and Brilliant Peel (BP)-assisted ILM peeling in patients with macular holes.

Methods: In a consecutive retrospective study in 41 eyes of 41 patients with macular holes a standardised 23-G transconjunctival sutureless pars plana vitrectomy with ILM-peeling and gas tamponade was performed. All patients underwent preoperative measurements of visual acuity (VA), the maximum hole diameter, basis, height, and intraretinal changes using high resolution optical coherence tomography (SD-OCT; Spectralis; Heidelberg Engineering). Main outcome measures included visual acuity 1, 3, and 6 months after surgery and the closure rate. We also evaluated photoreceptor inner/outer segment (IS/OS) integrity as seen in SD-OCT for correlation with visual outcomes after macular hole surgery.

Results: At baseline the mean best corrected visual acuity (BCVA) was 0.2 (0.77 logMAR). BCVA improved significantly to 0.4 (0.46 logMAR) after 1 month, to 0.44 (0.41 logMAR) after 3 months and to 0.58 (0.28 logMAR) after 6 months, respectively. A closure rate of 95.1 % was achieved. The morphological parameter photoreceptor IS/OS integrity was measured semiquantitatively and showed a positive correlation to BCVA.

Conclusion: Transconjunctival sutureless pars plana vitrectomy and Brilliant Peel (BP)-assisted ILM peeling in patients with macular holes is a very safe procedure and leads to good functional and anatomic results. The integrity of the IS/OS segment is a good predictive parameter for BCVA improvement after macular hole surgery.

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