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Daniele Veritti, Martina Santarelli, Gloria Dal Mas, Paolo Lanzetta; Morphological and Functional Correlations Before and After 25-gauge Surgery for Idiopathic Macular Pucker. A Spectral Domain OCT and Microperimetric Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2603.
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To investigate the relationship among functional and morphological findings before and after 25-gauge macular pucker surgery, using spectral domain optical coherence tomography (SD OCT) and MP-1 microperimetry.
Thirty-eight eyes of 36 patients with an idiopathic macular pucker who underwent 25-gauge transconjunctival sutureless vitrectomy and low concentration (0.05%) infracyanine green (IFCG) assisted internal limiting membrane (ILM) peeling were prospectively enrolled. Best-corrected visual acuity (BCVA) measurement, a complete ophthalmologic evaluation, SD OCT and MP-1 microperimetry were performed at baseline and at the last follow-up visit. SD OCT features include central retinal thickness (CRT) and the length of the disruption of inner segment/outer segment (IS/OS) junction (µm). MP-1 features include mean retinal sensitivity and fixation stability. Correlation between the amount of postoperative visual improvement and possible preoperative prognostic factors was statistically analyzed.
Mean follow-up was 18 ±9 months. Mean BCVA improvement was 0.34 ±0.2 logMAR (p <0.0001). Mean CRT reduction was 50 ±100 µm (p =0.0041). There was no significant difference in preoperative and postoperative IS/OS junction interruption length. The mean retinal sensitivity improvement was 0.9 ±2.6 dB (not significant). Patients with greater improvement of postoperative BCVA showed worse baseline BCVA (p <0.001), shorter final IS/OS interruption length (p =0.039) and thinner final CRT (p =0.035). A better final BCVA is influenced by shorter baseline and final IS/OS interruption length (p = 0.001), better baseline BCVA (p =0.044) and thinner baseline CRT (p =0.033). The presence of postoperative asymptomatic paracentral scotomata was detected with MP-1 in 8 eyes (21.1%). In 6 cases (15.8%) the scotomata were not present preoperatively.
Twenty-five-gauge transconjunctival IFCG assisted sutureless vitrectomy for macular pucker achieved an average BCVA gain of more than 3 ETDRS-lines. Baseline BCVA, CRT and IS/OS integrity detected by SD OCT can be used to predict the functional outcomes after macular pucker surgery. Paracentral scotomata observed in our series might be caused by trauma to the nerve fibers during ILM peeling, by IFCG damage to the neurosensory retina or by a combination of the two.
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