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Jack Shao, Peter Kaiser; Comparison Idiopathic Macular Hole Repair By Combination Vitrectomy Combined With Phacoemulsification Versus Sequential Surgeries. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2138.
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To compare macular hole closure rate, visual outcomes, and complications of 25-, 23-, and 20-gauge vitrectomy done in combination with phacoemulsification and intraocular lens implantation, with that of vitrectomy done after initial phacoemulsification and intraocular lens implantation, as well as with vitrectomy surgery done in pseudophakic patients. In addition, this study aims to compare visual outcome and complications of vitrectomy surgery that were done with indocyanine green (ICG) dye assistance as well as type of different type of gas (C3F8 or SF6) tamponade.
Eighty eight (88) consecutive undergone repair for idiopathic macular holes between January 2008 and December 2009 were reviewed. One group underwent combined surgery with vitrectomy, phacoemulsification with aspiration (PEA), and Intraocular lens (IOL) implantation (n = 51). A second group of pseudophakic eyes only underwent vitrectomy (n = 26). A third group of eyes with mild cataracts underwent vitrectomy without PEA or IOL implantation (n = 11). Postoperative best corrected visual acuity (BCVA) at 1 day, 1 week, 1 month, 6 month, and 1 year were collected. Percent improvement was calculated by the formula: (Postop LogMAR) / (Preop LogMAR) x 100.
The rate of primary macular hole closure in the combination group was 97.1% versus the sequential group of 96.1%. While the BCVA improved significantly at 1 year postoperatively (p < 0.001) in all groups, there was a significantly higher percentage of patients with ≥ 2 line improvements in BCVA in the combination group over the sequential group at 1 month, 6 month, and 1 year (p < 0.01, 0.03, 0.03, respectively). The consecutive group showed a significantly greater improvement in BCVA and percent change in BCVA compared to the sequential group. Postoperative BCVA and percent change in BCVA in the 25-gauge group improved significantly more than the 20-gauge group at 1 week, 1 month, and 6 months. A significantly higher percentage of patients who received SF6 during their vitrectomy surgery made ≥ 2 line BCVA improvement at 6 months than did patients who received C3F8 (p < 0.005). Complication rates were similar in all groups.
Combination surgery appears to be lead to better visual outcomes than sequential surgery in pseudophakic patients. Consecutive surgery in patients with mild cataracts at baseline was as effective as combination surgery. 25-gauge vitrectomy showed a faster improvement in visual acuity than both 20- and 23-gauge vitrectomy. Patients receiving SF6 showed a greater improvement in visual acuity than patients receiving C3F8.
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