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Y. V. Bayborodov, Jr., T. M. Dzhusoev, Jr.; Microinvasive Surgery Without Vitrectomy for Partial-Thickness Macular Holes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4202.
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Modern macular surgery implicates instruments with small diameters of 23G or 25G, which coordinates with two main principles of vitreoretinal surgery: minimal traumatizing and maximal safety. Use of xenon short-wave illumination allows in partial-thickness macular hole (MH) surgery performance of inner limiting membrane (ILM) peeling without prior vitrectomy. Purpose of this work was to develop a new technology of ILM peeling, using microinvasive approach of the macula without vitrectomy, with subsequent vitreous repair by means of hydrovitreoretinopexy.
Surgery was performed on 60 eyes of 40 patients with partial-thickness MH. Mean (±St.Dev.) preoperative visual acuity (VA) was 0.24 ± 0.12. Two transconjunctival ports were formed: one for the light pipe and another for the 25G forceps for ILM peeling. Forceps were gently conducted towards the macula. With a single move, ILM was captured, peeled and removed from the eye through the vitreous cavity. Then transconjunctival ports were closed and vitreous was injected with saline to achieve normotony. Patients were followed with VA measurements, ophthalmoscopy and optical coherent tomography (OCT) for one year after the surgery.
No intra-operative complications were observed during the procedure. On the first postoperative day, OCT showed full MH closure in 59 eyes; all patients noted improved VA and reduction of metamorphopsia. During the follow-up period, no proliferative tissue or cataract formation was observed. At the end of the one-year follow-up period, mean VA (±St.Dev.) was 0.71 ± 0.23.
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