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J.E. Nasemann, I. Gross; Morphological Alterations of Retina and Pigment Epithelium After Vitrectomy and ILM–peeling in Eyes With Idiopathic Macular Holes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5421. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare visual function after vitrectomy and ILM–peeling with results of postoperative macular imaging using a confocal scanning laser ophthalmoscope in eyes with idiopathic macular holes. Methods: Retrospective, non–randomized study in 31 eyes of 28 patients with idiopathic macular holes. All patients underwent vitrectomy with ICG–assisted ILM–peeling and fluid–gas–exchange. Best corrected visual acuity and results of macular perimetry were compared with postoperative images obtained by scanning laser ophthalmoscopy (SLO) at wavelengths of 488, 514, 633 and 780 nm and different direct and indirect confocal apertures. Results: A normal aspect of macular xanthophyll and foveal RPE could be demonstrated in 20 percent of eyes only. Disturbances of macular xanthophyll were found in 80 % and defects of subfoveal retinal pigment epithelium in 70 % of eyes. Fish–draught–like retinal surface changes within the area of ILM–denuded retina could be detected in 70 % of eyes. To the best of our knowledge hitherto undescribed numerous intraretinal microcystoid spaces of the retina were found in the 3 eyes mith macular holes that did not close after vitrectomy and to a minor extent in two eyes with closed holes. Patients that showed only mild alterations of xanthophyll and RPE had a significantly (p<0,01) better visual acuity (mean: 60/100) than patients with moderate or severe alterations (mean: 30/100) and also showed no central or paracentral visual field defects. Conclusions: After surgical repair of macular holes a number of morphological macular alterations can be demonstrated by direct and indirect confocal scanning laser ophthalmoscopy. The changes are located at retinal surface, within the retina and at RPE–level and are partly correlated with visual function.Whether the observed intraretinal microcystoid spaces are responsible for incomplete closure of macular holes after vitrectomy has to be investigated in a prospective study.
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