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Jacek Kotowski, Ebrahim Elborgy, Malav Joshi, Jackson Abou Chehade, Raymond Iezzi; Broad internal limiting membrane peeling and no face-down positioning for the repair of chronic idiopathic macular holes.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1079.
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© 2017 Association for Research in Vision and Ophthalmology.
To report anatomical and visual outcomes following chronic (duration > 12 months) idiopathic macular hole (MH) repair using broad internal limiting membrane (ILM) peeling and no face-down positioning.
Retrospective review of cases that underwent pars plana vitrectomy (PPV) with broad internal limiting membrane peeling, 20% SF6 or 14% C3F8 gas and no face-down positioning. Cases with MH duration of less than 1 year were excluded. There were no other exclusion criteria. Preoperative evaluation included Snellen visual acuity, slit-lamp biomicroscopy, dilated fundus examination, and optical coherence tomography (OCT). OCT was used for hole measurements and staging. Primary outcomes included anatomical closure rate and visual acuity on the most recent follow-up examination. For the purpose of statistical analysis Snellen visual acuity was converted to logarithm of the minimum angle of resolution visual acuity (logMAR). A paired t-test was used to determine if visual improvement was statistically significant.
10 eyes of 10 patients were included in this case series. 8 eyes had stage 4 MH, 1 eye had stage 3 and 1 eye had stage 2 MH. Mean MH duration was 7.4 years. 7/10 MHs had a basal diameter of more than 1000 μm. Mean preoperative visual acuity (VA) was 20/335. Anatomical success was achieved in 9/10 eyes with a single surgery. One eye required a second procedure. Mean postoperative VA improvement was 4.7 lines. VA improved in 9/10 patients and remained stable in 1/10. VA improved ≥ 3 lines in 7/10 patients and was ≥ 20/50 in 5/10 eyes.
This study demonstrates that face-down positioning may not be necessary to achieve a satisfactory anatomical closure rate in chronic and large idiopathic macular holes. Furthermore, no face-down positioning surgery for chronic macular holes may result in significant VA improvement and should thus be considered for patients who were previously unable or unwilling to undergo surgery due to postoperative positioning constraints.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Number and percentage of eyes according to visual outcome
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