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E.M. Biewald; Macular Hole Surgery: Results After a Three Months Post Surgical Follow–Up . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5541.
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Background: To compare the results of macular hole surgery using pars plana vitrectomy, internal–limiting membrane peeling and C3F8 16% gas tamponade combined with indocyanine green, autologous platelet concentrate or both. Design:Retrospective case study. Methods: All patients underwent pars plana vitrectomy, peeling of obvious epiretinal membranes, and intravitreous gas C3F8 16% with postoperative positioning. Group A (42 patients) was additionally treated with autologous platelet concentrate, group B (31 patients) was treated with indocyanine green assisted peeling of the internal limiting membrane (ICG–ILM) and autologous platelet concentrate (APC) and group C (35 patients) with ICG–ILM without APC. Main outcome measures: Comparing the visual acuity, closure rate and complications after a post surgical follow–up of three months. Results: In group B 68 % of the patients improved their visual acuity by 2 or more ETDRS–lines with a hole closure rate of 93 %. 51 % of the patients in group A gained postoperatively 2 or more ETDRS–lines with a hole closure rate of 84.2 %. In group C only 34 % showed visual acuity improvement by at least two lines or more, hole closure rate was 80,6 %. Postoperative complication rate in group A was 12 %, in group B 16%, and in group C 8,5 %. Conclusions: Only 34 % of the patients in group C who were treated with ICG assisted ILM peeling achieved a visual improvement by two or more lines compared to the good anatomic result with a hole closure rate of 80.6 % at the three months follow–up. Group A that was treated with APC alone achieved a significantly better visual outcome with a similar hole closure rate. The poor visual outcome of group C might be related to toxic effects of the indocyanine green dye and to the short postoperative follow–up. Group B that was treated with indocyanine green assisted ILM–peeling and autologous platelet concentrate showed the best results concerning visual and anatomical outcome. This good result could possibly be related to the simultaneously use of autologous platelet concentrate which might reduce the toxic effects of the indocyanine green dye. Long–term observation should clarify if the functional recovery in group C takes only longer than in the other groups.
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