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Xiao Zhang, Fangtian Dong; Lens capsular transplantation in the management of unclosed myopic macular hole. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1089.
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© ARVO (1962-2015); The Authors (2016-present)
To report a case of successful closure of refractive macular hole (MH) in a patient with high myopia.
Interventional case report. A 67y Chinese woman presented with decreased vision and metamorphopsia in her left eye. She was high myopia of -9.0D in both eyes. MH and posterior retinal detachment was detected in the left eye. After repeated operations, the MH was closed using lens capsular flap transplantation. Ophthalmic examinations and OCT were performed preoperatively and postoperatively.
At the first visit,BCVA was 0.06 OS. OCT revealed MH and retinal detachment OS, with minimal diameter (MD) of 845um. In Oct 2013, standard 23G PPV of the left eye was performed,ILM was peeled within the area of the arcade, and silicone oil tamponade was performed. As posterior retinal reattachment was not obtained, scleral shortening surgery was performed a week later. Two months after operation, OCT revealed unclosed MH with MD of 1470um, and mild detachment in the posterior retina. Because lens opacity was getting much prominent and silicone oil began to emulsify, Phaco, silicon oil extraction and 10% C3F8 tamponade was performed In Nov 2014. One month after operation, mild retinal detachment improved, but mh was unchanged, with MD of 1545um. A few days later, retinal detachment occurred, so fluid\air exchange and silicon oil tamponade was performed. Retinal reattached after operation, but MH was still open, with MD of 1684um. As MH was unclosed after silicon oil tamponade and retinal detachment occurred once silicon oil was removed, we have to think out another way to solve the problem. ILM within the arcade was peeled, so ILM transplantation was hard to perform. In Sep 2015, another surgery was carried out. After silicon oil extraction, an incision of the posterior lens capsular was made by the vitrectomy needle tip. A free capsular flap was obtained and trimmed to be slightly larger than the MH. The flap was stained with 0.125% ICG and inserted inside the MH, the margin of the flap was inserted under the neurosensory retina of the MH rim. After fluid\air exchange, 10% C3F8 tamponade was performed. 43 days after final operation, uncorrected visual acuity was 0.02, OCT revealed that the MH was closed and there was no subretinal fluid.
In case of refractive macular hole, when internal limiting membrane transplantation is not available, lens capsular flap transplantation could be considered.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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