Microperimetric Outcomes After 25-G Pars Plana Vitrectomy for Stage III/IV Macular Hole: A Prospective Study

Abstract

Purpose: : To evaluate tomographic results, visual acuity (VA) and microperimetric outcomes after 25-g pars plana vitrectomy (25gPPV) for stage III/IV macular hole (MH)

Methods: : Ten eyes of 10 patients with stage III/IV MH underwent 25gPPV with ICG-assisted ILM peeling. They were evaluated at baseline, and at 1 and 3 months postoperatively. Anatomical outcomes were evaluated by spectral domain OCT (SDOCT) (RTVue-100, Optovue Inc, Freemont CA, USA). Functional outcomes were evaluated by measuring visual acuity (VA) and retinal sensivity, fixation point stability (2° and 4°) by microperimetry (MP1, Nidek Technologies, Padova, Italy).

Results: : All the MHs were closed and flat at the end of follow-up, as confirmed by SDOCT. VA was significantly improved from baseline (0.97±0.35 Log MAR) at month 1 and 3 (0.58±0.33 and 0.51±0.31 LogMAR respectively; p<0.001). Retinal sensitivity did not improve significantly from baseline to month 1 (from 9.52±2.63 dB to 9.51±3.6 dB, p=0.98), but it was significant at month 3 vs baseline (12.29±3.45 dB vs 9.52±2.63 dB, p=0.006) and vs month 1 (12.29±3.45 dB vs 9.51±3.6 dB, p=0.039). Fixation stability into the central 2° did not change significantly at any point, Fixation stability into the central 4° improved significantly at month 3 vs baseline (97% vs 88%, p=0.01) and vs month1 (97% vs 92%, p=0.049). At baseline, the fixation point was located in all eyes at the edge of the hole, superonasally. After surgery the fixation point shifted centripetally toward the foveal center.

Conclusions: : Successful surgery for stage III/IV MH lead not only to VA improvement, but also to retinal sensitivity and fixation stability improvements and to the restoration of foveal fixation.

Keywords: macular holes • vitreoretinal surgery • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)