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Yaroslav Baiborodov, Tamerlan M. Dzhusoev, Jr.; 27-Gauge Surgery of I Stage Macular Holes without Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4478.
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To evaluate new microinvasive surgical strategy for preventive treatment of I stage macular holes.
The study included 12 patients (12 eyes), aged 51-75 years. All patients were diagnosed on optical coherent tomography (Cirrus HD-OCT) with foveolar adhesion of posterior hyaloid membrane (PHM) and cyst formation (stage I macular hole, Gass classification) and operated. Mean best-corrected visual acuity (BCVA) was 0.91±0.08. Surgical technique: two transconjunctival ports were formed, for the light pipe (Photon II mercury light source, Synergetics USA, Inc,) and for the 27-gauge forceps. The forceps was carefully conducted towards the macula; PHM was captured and detached from the foveola. This was followed by hermetic closure of the ports. Patients were followed with BCVA measurements, ophthalmoscopy, fundus photography, and HD-OCT for 6 months.
On the next day after surgery, HD-OCT showed complete detachment of the PHM from the fovea, without perforation, in all patients. Tears of internal limiting membrane were never observed. All patients subjectively noted improve in visual acuity (preoperative 0.91 ± 0.08, 6 months postoperative 0.95 ± 0.05) and decrease of metamorphopsia. During the 6-month follow-up period, no full-thickness or lamellar perforation was observed. In addition, no other side effects were present during the intra- or post-operative period.
27-gauge mechanical detachment of the PHM from the foveola without vitrectomy is an effective and safe method of prevention from formation of advanced macular holes, for it allows eliminating the main cause of the disease with minimal harm to the intraocular structures.
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