May 2004
Volume 45, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2004
Macular Hole Closure Rate Following Vitrectomy And 90 Degree Positioning
Author Affiliations & Notes
  • M.S. Romero
    University of Mississippi Medical Center, Jackson, MS
  • C.J. Chen
    University of Mississippi Medical Center, Jackson, MS
  • H. Wafapoor
    University of Mississippi Medical Center, Jackson, MS
  • Footnotes
    Commercial Relationships  M.S. Romero, None; C.J. Chen, None; H. Wafapoor, None.
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 1980. doi:
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      M.S. Romero, C.J. Chen, H. Wafapoor; Macular Hole Closure Rate Following Vitrectomy And 90 Degree Positioning . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1980.

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      © ARVO (1962-2015); The Authors (2016-present)

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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 
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