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S.A. Alpatov, A. Chtchouko, V. Malishev; Surgical Repositioning of Chronic Macular Hole Margins . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1457.
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To study the effectiveness of pars plana vitrectomy (PPV) with concomitant reposition of the hole margins in surgical treatment of chronic full–thickness macular holes.
Surgical treatment was performed on 25 eyes of 25 patients diagnosed with stage 3 to 4 idiopathic macular hole (group A). Surgery included standard 3–port pars plana vitrectomy, followed with internal limiting membrane peeling, assisted with indocianine green, and mechanical repositioning and compression of the hole margins. In order to achieve maximal anatomical closure of the hole, first, the gentle massage of the retina was performed around the hole moving from the periphery to center of the hole. After the gentle retinal massage, the hole always became smaller, however, the entire closure was never reached at this point due to either the large size of the hole or the rigidity of the surrounding retina. Subsequently to the massage, the margins were instrumentally lined up slightly overlapping one another, creating a single line. Then, a pressure was applied onto the repositioned margins, by means of forceps. In all cases, [[Unsupported Character – а]]t the end of the surgery, a fifteen percent perfluoropropane gas tamponade was performed. Postoperatively, prone position was required for as long as 2 weeks. For the comparison, a retrospective analysis of outcomes of surgical treatment of 27 eyes of 27 patients with stage 3 to 4 idiopathic macular hole (group B), whose surgery included standard 3–port pars plana vitrectomy, followed with internal limiting membrane peeling and gas tamponade, was performed.
Follow–up period varied from 6 to 12 months. Postoperative anatomical status of macular holes was determined with Optical Coherence Tomography at three defined end points, and categorized into flat / closed, flat / open and elevated / open. Overall closure rate was 92 ± 5,4% in the group A, and 86 ± 6,2% in the group B. Best–corrected visual acuity improved from 0.1 ± 0.014 (ranged from 0.02 to 0.5) before surgery to 0.29 ± 0.03 (ranged from 0.2 to 0.7) after surgery in the group A, and from 0.1 ± 0.05 (ranged from 0.05 to 0.4) before surgery to 0.22 ± 0.04 (ranged from 0.05 to 0.4) after surgery in the group B. Common postoperative complication in the group A was retinal pigment epitheliopathy, which developed in 18 cases (72%).
Suggested surgical instrumental reposition of macular hole margins in stages 3 and 4 of idiopathic macular holes results in promising anatomical and functional outcomes.
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