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Giancarlo Dell'Aversana Orabona, Angelo Rampone, Luigi Di Perna, Francesco Testa, Settimio Rossi, Michele Della Corte, Francesca Simonelli; Macular function in patients with macular pucker treated with 23 gauge vitrectomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3337.
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© ARVO (1962-2015); The Authors (2016-present)
The aim of this study is to investigate the effect of via pars plana 23 gauge vitrectomy in patients with macular pucker.
We followed up 7 patients with macular pucker (4 females and 3 males; age ranged from 67 to 86 years mean 75,9 ± 5,9 SD). The following examinations were performed before and 4 months after surgery: ophthalmoloscopic exam, best corrected visual acuity (BCVA), optical coherence tomography (OCT), microperimetry (MP-1) and multifocal electroretinography (mfERG). In particular, we studied the P1 wave in the six macular concentric rings as already described in literature. The surgical treatment was a via pars plana 23 gauge vitrectomy with ILM peeling and water tamponade.
The pre-operatory BCVA ranged from 0.2 to 0.5 (mean 0.33 ± 0.14) and from 0.3 to 1 (mean 0.73 ± 0.28) post-operatory. The OCT exam had shown a pre-operatory central macular thickness ranged from 366 to 605 µm (mean 458 ± 82.25 µm) and from 358 to 480 µm (mean 420 ± 122 µm) post-operatory. MP-1 had shown a preoperative sensitivity from 9.6 to 14.5 dB (mean 11.9 ± 1.7 dB) and a postoperative sensitivity from 7.8 to 18.0 dB (mean 13.4 ± 10.2 dB). In all patients the improvement of BCVA, OCT macular thickness and MP-1 macular sensitivity was not statistically significant. Instead, as regards mfERG responses, after surgery, namely the number of recordable P1 waves in the second ring increased significantly (Fischer test, p: 0.029) and the P1 wave amplitude in the third ring decreased significantly after surgery (Wilcoxon Signed Rank Test, p: 0.04). Moreover, we observed a significant correlation between the central macular thickness and the Inner/Outer Segment junction photoreceptor layer (Spearman rho=-0.79; p: 0.03).
This study revealed that surgical treatment of macular pucker with the MLI peeling induced a reappearing of electrical activity in the central macular region (in the second ring) probably due to the resolution of the macular traction, but, at same time, P-wave amplitude in peri-central macular region (third ring) was reduced, probably, for the removal of generative electrical stimulus cells during the surgery. The surgical treatment also resulted in an improvement of BCVA, OCT macular thickness and MP-1 macular sensitivity, even if no statistically significant differences were observed.
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