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S.J. Patel, Q.D. Nguyen, J.A. Haller, J.T. Handa, I. Zimmer–Galler, D.V. Do; Visual and Anatomical Outcomes After 25–Gauge Transconjunctival Sutureless Vitrectomy for Macular Holes . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4652.
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© ARVO (1962-2015); The Authors (2016-present)
Despite the recent increase in the use of 25–gauge transconjunctival sutureless vitrectomy (TSV) system, few published reports in exist about visual and anatomic outcomes of TSV for idiopathic macular hole (MH). The goal of this study is to report visual and anatomic outcomes in eyes undergoing TSV for MH.
Retrospective review of all cases of TSV for idiopathic MH performed between January 2001 and June 2005 at the Wilmer Eye Institute was completed. Outcome measures included visual acuity, follow–up duration, intraocular pressure, postoperative complications, and anatomic closure of MH.
Twenty–four eyes of 24 patients with MH were identified. Twenty one had new MH and 3 had recurrent MH. Average duration of symptoms was 3 months (range 1 week to 12 months). Sixteen patients (66%) were female. Average age was 66 years (range 42 to 85 years). Median follow–up time was 5 months (range 2 to 19 months). Median preoperative and postoperative visual acuity was 20/100 and 20/80. Median preoperative and postoperative IOP were 15mmHg. Sulfur hexafluoride (median 20%) was used in 7 patients and perfluoropropane (median 15%) was used in 17. Anatomic closure was recorded in 20 out of 23 patients (87.5%). Three patients required repeat vitrectomy for failure of closure, among whom 1 had closure with the 2nd surgery. Postoperative complications included cystoid macular edema in 2 patients (8%) and retinal detachment (RD) in 3 patients (12.5%). Among the 3 RD patients, the MH was closed in all at the last follow–up. No complications due to hypotony were noted.
This study contains the largest series of patients who have undergone TSV for MH and suggests that anatomic closure rates and postoperative complications with TSV for MH are comparable to published rates with 20–gauge vitrectomy. TSV offers distinctive advantage over 20–gauge system. A prospective, randomized, controlled trial is necessary to evaluate properly visual outcomes and safety between the two surgical approaches.
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