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S. Rogers, K. C. Madhusudhana, K. H. Kang, A. Luff, C. Canning, R. Newsom; Combined Phacovitrectomy for Macular Hole: Long-Term Results. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4125.
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To present the long-term results of patients undergoing combined phacovitrectomy surgery for full-thickness macular hole (FTMH) at a single centre.
A retrospective chart review of patients undergoing combined phacovitrectomy for FTMH over an 18-month period was conducted. All patients underwent phacoemulsification through a clear corneal incision with posterior chamber lens implantation, followed by standard 3-port pars plana vitrectomy with air-fluid exchange and gas injection. Internal limiting membrane was peeled with the aid of trypan blue or ICG in all cases, except for small stage II holes. Patients were not subjected to postoperative posturing. Snellen visual acuity, macular hole details and operative complications if any, were recorded. Snellen visual acuity was converted to LogMAR scale for analysis.
Fifty-nine patients (63 eyes) were included in the study. There were 20 men and 39 women. The mean (± SD) age was 69.3 (± 7.7) years. Mean LogMAR vision at baseline was 0.86. The mean follow up was 10.7 months.Data was available for 47 patients who had a follow-up of more than twelve months (Mean= 22.1 months). At final follow-up (N= 47), 78.7% of eyes achieved an improvement in LogMAR vision, with a mean increase by 0.37 units. LogMAR vision improved in 68% of eyes by more than 0.3 units. Macular hole closure was achieved in 79% of patients after one operation. Hole closure rate at final follow up was 87% .The commonest intraoperative complication was iatrogenic retinal break, found in 13 of 63 eyes (20.6%). Posterior capsular opacification was the most common postoperative complication, which occurred in fourteen eyes (22.2%). Two of the 63eyes (3.2%) developed retinal detachment; one of these had intraoperative retinal tears treated during surgery. Eight eyes (12.9 %) required further surgery for persistent macular hole; all but two eyes achieved hole closure after the second procedure.
This study shows that the surgical results of phacoemulsification combined with vitrectomy for FTMH are comparable to vitrectomy alone in terms of improvement in visual acuity and macular hole closure rate. The combined surgery appears to be safe and enables early visual rehabilitation avoiding a second surgery to remove cataract. Pseudophakic eyes allow a more complete vitrectomy, while providing a better fundal view for visualising the epiretinal membrane and any iatrogenic retinal tears.
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