Abstract
Abstract: :
Purpose: To evaluate the closure rate of macular hole (MH) following pars plana vitrectomy (PPV) and maintaining a 90 degree head positioning. Methods: A retrospective chart review of 49 patients (52 eyes) that underwent MH surgery from July 2000 to January 2003 was performed. A complete ocular examination was performed preoperatively. Best corrected visual acuity (VA) was measured by standard Snellen chart .The diagnosis of MH was established at slit lamp using a 90 diopter lens and confirmed by optical coherence tomography (OCT). All patients were diagnosed with idiophatic MH, 3 eyes had stage II MH, and 49 eyes stage III and IV MH. Patients with recurrent hole were also included. Following surgery patients were instructed to maintain a 90–degree position during two weeks. PPV and internal limiting membrane (ILM) peeling with indocyanine green (ICG) and 10–14% C3F8 gas tamponade was performed in all eyes. Results: The follow–up period was 6–27 months; 71% of the patients were observed for more than 1 year. The success rate for MH closure after one surgery was 85% (44 of 52 eyes), and with additional vitrectomy surgery, the total success rate was 92% (48 of 52 eyes). Preoperatively 92% of the eyes had VA worse than 20/50. Postoperatively, 63% of eyes achieved more than 2 lines of improvement in VA with 33% obtaining 20/40 or better. VA was worse than 20/50 in 58% of eyes. Significant complications included retinal detachment (three eyes), central retinal vein occlusion (1 eye), cystoid macular edema (1 eye), and dislocated intraocular lens (1 eye). Conclusions: Successful MH closure was possible with 90 degree positioning. The higher rate of MH closure in this study, compared to a similar previously reported technique might be due to ICG assisted ILM dissection. This approach should be considered for those patients unable to tolerate face–down positioning.
Keywords: macular holes • visual acuity • macula/fovea