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Lochan Bellamkonda, Kamal Kishore; Persistent Macular Holes after Vitrectomy Combined With Routine Peeling of the Internal Limiting Membrane (ILM). Invest. Ophthalmol. Vis. Sci. 2014;55(13):312. doi: https://doi.org/.
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To investigate predictive factors for persistent macular holes following vitrectomy, gas and peeling of ILM, and report on the outcomes following repeat vitrectomy procedure for such eyes.
A retrospective chart review of 152 eyes of 143 consecutive patients undergoing surgery for idiopathic full-thickness macular holes between April, 2003 and June, 2013 by a single surgeon was conducted. Six eyes failed to close after initial surgery. Patients' age, hole size, duration of symptoms, lens status, gas tamponade, preop visual acuity (VA) were analyzed to investigate predictive factors for persistence. Data were collected on anatomical and visual outcomes following repeat surgery for these holes. Size was measured with OCT (81 eyes) or on fundus photos (remaining eyes). Face-down (FD), or eye-down (ED) positioning for one (SF6) to two (C3F8) wks was utilized during initial surgery. Repeat surgery, after a mean of 6 (range 3-10) wks, consisted of ILM peeling over a wide area, almost to the arcade, and 18% C3F8 tamponade followed by 2 wks of FD or ED positioning. For ED positioning, patients were advised to read or perform fine visual task such as watching a movie gazing at a book or electronic device placed horizontally at or below their chest level. They were also advised to take 10 minutes break every hr. Diluted (1:10) triamcinolone acetonide was used to help visualize ILM during repeat surgery, and most cases of primary surgery. Two-sample t-test and Fisher Exact test were used for statistical analysis.
No statistically significant difference was observed between “Successful” and “Persistent” groups in the parameters studied (Table). All six persistent holes closed after repeat surgery. After 5-17 (mean 9+/-5) follow up, 3 eyes gained >0.2 logMAR, one eye was stable, and two eyes suffered decline in >0.2 logMAR (one due to cataract and other due to dry AMD). Mean gain in VA, and final VA after repeat surgery were 0.25 and 0.78 (Snellen 20/120) logMAR, compared to 0.3 and 0.46 (Snellen 20/60) logMAR for “successful” group, P=0.83, and 0.07.
Success rate for initial surgery was 96%, and remaining holes closed with repeat surgery. Patients with hole closure after initial surgery showed a tendency towards better final VA. We were unable to find statistically significant preoperative parameters between the two groups.
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