Experiences and Outcomes of Idiopathic Macular Hole Repair Using the Transconjunctival, Sutureless 25–Gauge Vitrectomy System

Abstract

Abstract: : Purpose: To investigate our surgical experience and outcomes of macular hole surgery utilizing the transconjunctival sutureless 25–gauge vitrectomy system. Methods: Retrospective case series of 11 consecutive patients undergoing idiopathic macular hole repair over a 6 month time period. All cases underwent 25–gauge pars plana vitrectomy with removal of the posterior hyaloid, injection of a long–acting gas tamponade(8 patients received SF6 gas, and 3 patients received C3F8 gas), and postoperative prone positioning. Internal limiting membrane (ILM) peeling around the macular hole was performed in 9 patients with indocyanine green (ICG) assistance in 8 of the patients. The follow–up period ranged from 1 to 5 months. Results: Ten of 11 eyes (91%) achieved hole closure on the initial procedure. In the failed case, the macular hole re–opened as a result of a post–operative rhegmatogenous retinal detachment. Vision improvement was seen from a mean of 20/163 preoperatively to 20/67 postoperatively. Of the 8 patients who had SF6 gas tamponade, the mean 2 week postoperative vision was 20/52, representing 88.8% of the final mean vision of 20/46. There were no instances of postoperative hypotony or wound leaks. Three patients developed postoperative ocular hypertension, which was controlled with medication or discontinuation of corticosteroids. One patient was noted to develop intraoperative retinal breaks, which were successfully treated during the procedure. Conclusions: Transconjunctival, sutureless 25–gauge vitrectomy achieved favorable anatomic and visual outcomes for macular hole surgery. Longer–term analysis as well as comparative studies to outcomes and techniques of traditional 20–gauge vitrectomy are warranted.

Keywords: macular holes • clinical (human) or epidemiologic studies: outcomes/complications • retina