Oxane HD as Internal Tamponade in the Treatment of Persisting Macular Holes

Abstract

Abstract: : Purpose: to evaluate the efficacy of Oxane HD as retinal endotamponade in the treatment of persisting macular holes (PMH). Methods: 3 patients affected by PMH after previous surgery including peeling of the internal limiting membrane (ILM) and long–acting gas endotamponade, underwent re–pars plana vitrectomy and Oxane HD endotamponade. Oxane HD is a heavier–than–water substance (Silicone Oil 5.700 mPas–RMN3 mixture) with a viscosity of 3.300 mPas and a density of 1.02 g/cm³. Intraoperative 0.05% ICG staining did not highlight any residual ILM or tractions. After 3 months the endotamponade was replaced with BSS. The visual outcome and the OCT findings were recorded.Follow–up was 10 months. Results: in all patients preoperative OCT showed a full–thickness macular hole with elevated margins and no evidence of residual tractions. Postoperative OCT showed the anatomic closure of the PMH. Visual acuity increased respectively from 20/100 to 20/40, from 20/600 to 20/100, from 20/100 to 20/50. OCT images during the endotamponade showed the Oxane bubble fitting the foveal profile in all patients. During the endotamponade period we did not observe alterations of the intraocular pressure, emulsification or new membrane formation. Conclusions: pars plana vitrectomy, ILM peeling and intraocular gas tamponade achieve the closure of macular holes in over 90%. The failure of the primary surgery may be due to residual epiretinal tractions, insufficient gas tamponade or poor patient’s compliance in keeping the prone position. Surgical treatment of PMH is still difficult. Retreatment with silicone oil as endotamponade can lead to closure of the PMH, but the visual outcome is often poor, probably because it floats and does not conform well the foveal depression, leaving an empty interface. As OCT findings showed, Oxane HD is heavier–than–water, sinks and therefore achieves a good tamponading effectiveness on the foveal region in the sitting position, allowing the good anatomical and functional recovery. In our series no residual ILM or tractions were displayed, therefore the failure was probably due to poor compliance. Oxane HD may be a useful tool because prone positioning is not necessary.In conclusion these case reports show that Oxane HD in the treatment of PMH is a safe and effective technique that effectively tamponades the macular region and can lead to visual improvement. Further studies on a greater amount of patients are necessary to confirm these results.

Keywords: macular holes • vitreous substitutes