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C.C. Brown, D. Miller; Results of Surgical Management of Senile Macular Holes by 25–Gauge Trans–Conjunctival Sutureless Vitrectomy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4641.
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© ARVO (1962-2015); The Authors (2016-present)
To assess anatomic, visual results, and complications of macular hole repair via 25 gauge trans–conjunctival sutureless vitrectomy.
Twenty–four eyes of 24 consecutive patients who presented with symptomatic (via decreased visual acuity) senile macular holes treated via 25 gauge trans–conjunctival vitrectomy were retrospectively reviewed. All 24 patients received a complete pre– and postoperative ophthalmologic examination. All patients had a core vitrectomy, confirmed posterior hyaloid separation, and indocyanine green assisted peeling of the internal limiting membrane. Intraocular gas tamponade was performed with 12 to 15% C3F8, except 20% SF6 in one patient. No sclerotomies were sutured. Facedown position was recommended for 1 week to all patients. There were no adjuvant therapies used during the procedures. Macular hole closure, visual improvement, and complications were analyzed with a minimum of 3 months follow–up.
Complete macular hole closure was achieved in all of the 24 eyes analyzed to date. Closure was confirmed clinically at >3 month follow up when peripheral edges of the hole remained flat against the RPE. Mean Age of the patients evaluated was 69.6 (S.D. ±6.91) years old, 58.3% were female. 14 patients (58.3%) presented with associated posterior vitreous detachment, and 11 patients (45.8%) presented with an epiretinal membrane. Each patient had recognized a decrease in visual acuity preoperatively per history. Postoperative visual acuity improvement was documented in 13 of 24 patients, with 5 of 24 reporting no significant change in vision, and 5 of 24 patients with worsening visual acuity postoperatively. Phakic patients had worsening cataract postoperativley. Average visual acuity improvement was –0.274 per log MAR calculation, which correlates to improvement of three Snellen lines. The only noted complications were 2 patients with self–limiting hypotony that resolved in 1 week with observation.
This review suggests that the successful surgical management of senile macular holes via 25 gauge transconjunctival sutureless vitrectomy is plausible.
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