Abstract
Purpose: :
To evaluate the outcomes of 25-gauge vitreoretinal surgery for chronic macular holes (> 12 months duration).
Methods: :
A retrospective review of patients seen from August 2005 through October 2008 who underwent single-surgeon (SMH) 25-gauge pars plana vitrectomy, internal limiting membrane peel with Kenalog visualization, 14% C3F8 gas-fluid exchange and one week post-operative face-down positioning.
Results: :
24 eyes of 22 patients underwent surgery for stage 3 or 4 idiopathic chronic macular hole. Mean follow-up was 11.9 months (median 11.0, range 1 - 30 months). Mean patient age was 71.3 years. Mean duration of the macular hole was 42.7 months. Mean preoperative logarithm of the minimum angle of resolution visual acuity (LogMAR VA) was 1.13 (20/270) with a range of 0.4 - 3.0 (20/50 to hand motion). Mean postoperative LogMAR VA was 0.74 (20/110) with a range of 0 - 2.0 (20/20 to count fingers at 5 feet), a statistically significant improvement (p=0.006). Eleven of 24 eyes (46%) eyes had improvement of visual acuity, defined as halving of the visual angle, on most recent exam. Nineteen out of 24 eyes (79%) achieved anatomic closure on clinical exam and optical coherence tomography (OCT). These eyes had significantly better mean postoperative VA than eyes without closure; LogMAR VA was 0.63 (20/85) and 1.16 (20/290) for closed and open cases respectively (p=0.006), despite similar preoperative visual acuities of 1.22 (20/330) and 1.10 (20/250) respectively (p=0.35). During the follow-up period, four of 15 eyes (26.6%) that were phakic preoperatively underwent phacoemulsification for visually significant cataract an average of 4.1 months after chronic macular hole repair.
Keywords: macular holes • vitreoretinal surgery • macula/fovea