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P. Busatto, G. Di Giorgio, G. Driussi, F. Barosco, M. Chizzolini, G. Beltrame; Differences in Internal Limiting Membrane Removal With or Without PFCL Assistance During Macular Hole Surgery . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5641.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate anatomic and functional results of an original surgical technique used during idiopathic macular hole surgery. To describe and discuss preliminary results of a prospectic surgical trial.
Two groups of eyes ( group A: 31 eyes of 31 patients, mean age 68 years old,17 female and 14 male; group B: 25 eyes of 25 patients, mean age 71 year old, 13 female and 12 male) with stage 3 and 4 Gass classification macular hole have been operated . They were preliminary studied by bio microscopy and OCT Stratus III Zeiss. Surgery consisted in pars plana vitrectomy, with internal limiting membrane (ILM) peeling without dye staining and in group A, 1cc injection of liquid perfluorocarbonate (PFCL).We didn't adopted PFCL in group B. Using Eckardt forceps to remove ILM, we guided hole closure, in the same way as it happens with silicone oil in Pertile and Claes technique. PFCL than was changed with a mixture of air and hexafluorur of sulphur (SF6). Patient was raccomended to maintain face down position for some days (usually 5–7). In 8 cases in group A and 5 cases in group B we performed contemporary cataract extraction by phacoemulsification. Macular OCT was repeated 1, 6 and 12 months after surgery.
In group A and B respectivelly 29 and 22 eyes had intra operatory hole closure. In 2 cases hole reopened in group A, in 3 cases in group B.Visual acuity significantly improved in about 49% of cases, remained the same in 49% of cases and worsened in 2% of cases in both groups.
Till Kelli and Wendel 1991 article, idiopatic macular hole surgical technique underwent multiple changes. Despite continuous improvements, alternative methods used till now not seem completely suitable to guarantee best visual acuity. Moreover, hole fisiopathology, is not completely understood. PFCL represents an important surgical tool during macular hole surgery to evaluate ILM peeling without dye use. This is of fundamental importance to remove tractions on hole and to improve the success rate from 93.1% (ILM peeling and gas tamponade) to 95.3% ( PFCL assisted ILM peeling and gas tamponade). Macular hole closure using PFCL, as we have described, seem to represent an useful option of all techniques till now proposed.
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