Purchase this article with an account.
K. Chalioulias, L. Wehbeh, M. Mughal, R. Scott, G. Kirkby; Platelets and ILM Peel in Macular Hole Surgery: A Retrospective Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4121.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To find the best timing and surgical technique for different grades of macular holes.
Retrospective analysis of medical notes. 217 patients were included in this study. 202 case notes were reviewed, with a total of 227 eyes operated, over a period of 10 years. All the operations were performed or directly supervised by two surgeons. The mean age of the patients involved in this study was 67.78 years (16-84). 68 eyes had stage 2 macular holes, 99 stage 3, 27 stage 4(33 were not graded).The mean duration of patient symptoms was 9.45 months (1-48 months). The mean clinical follow up for these patients was 8.87 months (1 week - 80 months).
The macular hole closure rate was 81.53%. 210 operations were performed with platelets, 12 without (5 not known).Out of the 210 eyes that had platelets, 83 eyes underwent internal limiting membrane (ILM) peel and 122 didn’t (5 not known). ILM peel did not improve the closure rate. Two types of gases in different quantities were used, SF6 and C3F8, which did not alter the surgical outcome. On stage 2 macular holes waiting time did not affect the surgical success but had an adverse effect to the visual outcome with a cut off point (VA improvement below average) at 6 months, whilst ILM peel did not affect the closure rate or the visual outcome. The results were the same for stage 3 macular holes, but the cut off point was at 10.5 months and ILM peel had a worse visual outcome. For stage 4 macular holes waiting time and ILM peel do not significantly affect the closure rate or the visual outcome.
In our group of patients that underwent vitrectomy with platelets, waiting time for macular hole surgery affects the visual outcome for stage 2 and 3 macular holes, but does not have a significant effect for stage 4 holes. ILM peel does not offer any advantage regarding anatomical closure and decreases VA improvement in stage 3 macular holes. Patients who present with stage 2 macular holes should have their surgery less than 6 months since the initiation of symptoms, to achieve the best visual outcome and patients with stage 3 should be operated before 10.5 months.
This PDF is available to Subscribers Only