Abstract
Abstract: :
Purpose: To evaluate a new minimal surgery in the management of macular hole (MH), and try to decrease secondary retinal detachment (RD) and cataracts. To demonstrate the effects and efficiency of this surgical technique on the retina with Scanning Laser Ophtalmoscopy (SLO) Heidelberg (without injection) and Optical Coherence Tomography (OCT). Methods: We have analyzed data from thirty eyes of 30 patients with MH treated between January 2000 and October 2002. We used a two-ports pars plana limited vitrectomy . Posterior hyaloid and internal limiting membrane (ILM) were peeled in the same time, by using a vitreoretinal pick, a curved blade and an intraocular forceps. ILM visualization was easy by using an external slit-lamp light. After closing sclerotomies, fluid and vitreous liquid were passively aspirated out of the eyes, using a syringe of pure sulfur hexafluoride (SF6) injected via the pars plana. Another needle was placed temporarily on the other superior opposite side in order to make a fluid-gas exchange without elevated intra ocular pressure. It allowed infusion of a large bubble of gas. (Mean 2,3 ml). Facedown positioning was recommended for about one week VA, fundus with evaluation of the macula, SLO and OCT examinations (pre-operative, after 15, 30 and 90 days, and after several months) were performed. Results: Two of 30 eyes had a stage 2 MH and 28 eyes had a stage 3. The mean follow-up period was 18 months. Preoperative visual acuity (VA) ranged from 20/40 to finger counting. Surgery resulted in final anatomic success in 29 eyes but one eye had an inferior RD and a smaller but still opened MH. All patients had ILM peeled completely or almost.VA and reading capability improved in 29 eyes (97%)by 2 lines or more, and in 1 eye had stabilized visual acuity. The mean visual acuity improvement was 4,2 lines and the mean reading capability improvement was 4,5 lines. Unperfected degree of positioning was associated with obesity (97%) and a mean VA improvement of 2,2 lines. Nuclear cataract increased in five patients.SLO temporarily showed macular small areas of defects with the autofluorescent filter until the 30th day after surgery. Green-free filter showed the ILM area of dissection till the first month and red-free till the third. OCT demonstrated MH repair with a flat fovea area and disappearance of fovea cysts until the 30th day. Anatomical fovea restoration is achieved between one and three months after surgery. Conclusion: This study seems to confirm the possibility to repair MH with a minimal surgery and to understand better it with the help of SLO and OCT. CR: None
Keywords: macular holes • vitreoretinal surgery • retina