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M. Sakamoto, H. Sakamoto, K. Ito, Y. Nishioka; Removal of Submacular Massive Hard Exudates Through the Intentional Macular Hole in Patients With Diabetic Maculopathy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):999.
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To report a surgical procedure for removal of submacular hard exudates through the intentional macular hole in patients with diabetic maculopathy.
We performed vitrectomy for diabetic maculopathy to remove submacular hard exudates in three eyes of two patients. In all eyes, subretinal massive exudates were observed by funduscopic examinations and serous retinal detachment at fovea was observed in optical coherence tomographic (OCT) images. Preoperative visual acuity (logMAR) was 0.6 or less in every eyes. After pars plana vitrectomy, submacular hard exudates were washed out through the intentional macular hole with a back flush needle. In all cases, internal limiting membrane peeling and fluid air exchange were also performed. We evaluated this tecnique by the visual acuity results and postoperative complications.
Submacular hard exudates located in the subretinal space were sufficiently removed by the surgical treatment. Following the removal of submacular hard exudates, visual acuity was improved in all eyes. We could confirm in OCT that the intentional macular hole was completely closed after vitrectomy. We found no serious complications related to subretinal washout through the intentional macular hole.
The previous reports indicated that the visual prognosis was worse in cases of diabetic maculopathy with submacular hard exudates and serous retinal detachment before or after vitrectomy. To remove submacular hard exudates through the intentional macular hole was considered an effective technique for the treatment of such poor prognostic cases. Further study will be necessary to evaluate the efficacy of this method, comparing to the previous methods with washout through the parafoveal intentional hole.
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