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Naina Gupta, Demetrios Vavvas; Success of Fellow Performed Macular Hole Surgery without Internal Limiting Membrane Peel and with Limited Positioning. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2617.
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Macular hole repair is a surgical technique taught to vitreo-retinal fellows at many institutions around the nation. However, no studies report the effect of the fellow performance on the surgical success rates of macular hole repairs. This study aims to report anatomic and functional success rates following macular hole repairs conducted by fellows in a large teaching institution without removal of the internal limiting membrane.
A retrospective chart review was conducted on patients undergoing macular hole surgery by a fellow at the Massachusetts Eye and Ear Infirmary. End-points of the study included anatomic closure, best corrected visual acuity, and complications. For statistical analysis, final vision outcomes were specifically noted for visual acuity of 20/50 or better. Anatomic closure was detected using OCT imaging.
26 patients were eligible for inclusion in the study. The minimum follow-up interval was 3 months. The anatomic closure rate was 92.3% (24/26). 80.8% of patients (21/26) had a post-operative visual acuity of 20/50 or better. No complications secondary to the operation were reported.
This study indicates that successful outcomes can be achieved by fellows when compared to previous literature in which similar techniques were used by surgeons reporting anatomic closure rates ranging from 48 - 91.7%. Internal limiting membrane peeling was not found to be necessary for successful macular hole repair as notable rates of anatomic success and improvement in visual acuity were achieved without peeling of the ILM.1. Brooks HL. Macular Hole Surgery With and Without Internal Limiting Membranes. Ophthalmology 2000; 107:1939-48.2. Tognetto D, Grandin R, Sanguinetti G, et al. Internal Limiting Membrane Removal during Macular Hole Surgery. Results of a Multicenter Retrospective Study. American Academy of Ophthalmology 2006; 113:1401-10.3. Margherio RR, Williams GA, Chow DR, et al. Effect of Perifoveal Tissue Dissection in the Management of Acute Idiopathic Full-Thickness Macular Holes. Arch Ophthalmol 2000;118:495-98.4. Lois N, Burr J, Norrie J, et al. Internal Limiting Membrane Peeling versus No Peeling for Idiopathic Full-Thickness Macular Hole: A Pragmatic Randomized Controlled Trial. Invest Ophthalmol Vis Sci 2011; 52:1586-92.
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