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Hendrik Schwarzer, Babac Mazinani, Niklas Plange, Peter Walter, Gernot Roessler; Anatomical and Functional Outcome of Heavy Silicone Oil in Complicated Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3769.
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© ARVO (1962-2015); The Authors (2016-present)
To demonstrate the outcome of macular hole (MH) surgery with heavy silicone oil (HSO) in 27 patients suffering from large MHs or persistent MHs following primary surgery using sulfur hexafluoride (SF6) gas endotamponade.
27 patients were included in this restrospective study out of which 19 underwent primary vitrectomy with internal limiting membrane (ILM) peeling and SF6 gas endotamponade but due to a persistent MH had to undergo secondary HSO surgery. In 8 eyes due to special clinical circumstances, such as large hole size, prolonged history of the MH or both, ILM-peeling combined with HSO endotamponade was chosen primarily. Two different types of HSO were used, Oxane®HD (Bausch & Lomb, n=10) and Densiron®68 (FLUORON, n=17) respectively. HSO removal was performed after a mean period of 13.8±6.4 weeks. In 12 cases surgery was combined with cataract extraction, either combined with HSO insertion or removal. Final examination including best corrected visual acuity (BCVA), indirect ophthalmoscopy and optical coherence tomography (OCT) was performed at least 3 months after HSO removal.
The mean gain of visual acuity in all 27 eyes was 2.3±2.67 lines logMAR after HSO removal. 6 patients improved by 1-2 lines, 8 patients by 3-6 lines and another 5 patients improved by 5-9 lines. In 5 patients visual acuity could not be improved and only 3 deteriorated by at most 1 line. At the end of follow up time 19 (70%) of all MHs were closed entirely. In 26 (96%) of the MHs the edges were flat, of which in 8 (30%) cases the hole margins were adhered but an anatomical defect could still be observed due to the pre-operative large MH size. In 11 (40%) cases the presence of emulsificated oil in the AC could be observed. 10 (90%) of these patients had Densiron®68 silicone oil installed whereas in only one patient with Oxane®HD emulsification could be seen.
According to our analysis HSO surgery in complicated MHs might be an efficient approach for permanent closure. In most cases BCVA could be improved. In several cases emulsificated oil was seen. Interestingly 90% of which emulsificated in those cases where Densiron® 68 had been used. However, further investigations with a larger compound of patients might be useful to confirm our findings in regard to this complication.
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