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Matthias D. Becker, Magdalena Toenz, Stephan Michels; Status Of Posterior Vitreus Detachement In Full Thickness Macular Holes And Macular Pucker. Correlation Of OCT And In-vivo Clinical Findings. Do We Judge Right?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4488.
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Comparison of intraoperative vitreous triamcinolone acetonide (TA) staining in full-thickness macular holes vs macular pucker.
In a retrospective case series we analyzed the presence of a posterior vitreous detachment (PVD) in 40 eyes of 40 consecutive patients with full-thickness macular holes (FTMH) compared to 60 eyes of 60 consecutive patients with macular pucker (MP). Most patients underwent OCT imaging and all standard TA assisted three port pars plana vitrectomy, ILM membrane peeling and intraocular gas or air tamponade, respectively. The status of the posterior vitreous cortex was judged by intravitreal TA staining after core vitrectomy.
The posterior vitreous cortex was firmly adherent in 28/40 eyes (70%) in MH patients, and only in 16/60 in MP patients (26.7%). Common finding in all patients with no PVD was a convex shaped bursa premacularis. In these cases a PVD was only inducable by vigorous suction with the vitreous cutter after visualization with TA. Pre surgical evaluation using SD OCT was performed in 50 patients. SD-OCT findings regarding a PVD were consistent with intra-operative findings in only 4 of 11 FTMH and in 28 of 39 MP.
The firm adherence of vitreous cortex in a majority of FTMH patients compared to patients with MP could contribute to the pathogenesis of FTMH. Pre surgical SD OCT findings regarding a PVD were frequently inconsistent with intra-operative findings. Further optimization of pre-surgical vitreo-retinal interface imaging and better understanding of the role of the bursa premacularis in the pathogenesis of macular disease is needed.
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