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T. M. Dzhusoev, IV; Surgical Treatment of Macular Holes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4118.
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© ARVO (1962-2015); The Authors (2016-present)
To develop optimal extension for removal of retinal internal limiting membrane (ILM) in surgical treatment of macular holes.
140 patients operated for macular holes were subjects of the study. Surgical procedure included 3-portal 25-guage vitrectomy, peeling of kenalog-contrasted posterior hyaloid membrane, and circular removal of ILM without use of dye. Extension of ILM removal was defined according to the diameter of macular hole. In stage II macular holes with the diameter of 200-450 micrometers (µm), ILM rhexis 2000 µm in diameter with subsequent air tamponade were performed. In stage II macular holes with the diameter of 451-700 µm, ILM rhexis 3500 µm in diameter with subsequent air tamponade were performed. In stage IV macular holes larger than 700 µm in diameter, ILM rhexis of 4500 µm in diameter and tamponade with mixture of air and heavy gas were performed. Patients were followed with standard ophthalmological exam. Optical coherent tomography (OCT) ("Stratus" Carl Zeiss, Germany) was used as main diagnostic criteria to confirm anatomical closure of the hole.
OCT-confirmed closure of macular hole was achieved in 135 patients on the next day after surgery. 5 patients with giant macular holes larger than 1200 µm OCT showed reduction of the holes in diameter but full closure was not achieved.
We believe that the proposed extensions of ILM removal in macular hole surgery, based on the diameter of macular hole, is an effective surgical approach allowing to achieve closure of the hole on the next day after surgery.
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