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S. Vehr, U.E. Schnurrbusch, P. Wiedemann, S. Wolf; Prospective Study for the Comparison of Two Surgical Procedures in Idiopathic Macular Hole . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3042.
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Purpose: To compare results of surgery for idiopathic macular hole with peeling of the internal limiting membrane (ILM) and autologous platelet concentrate (APC) as an adjuvant. Methods: In a prospective randomized clinical trial we included 40 patients with full-thickness macular holes. Inclusion criteria were idiopathic macular holes stage 2 or 3 according to Gass, age over 40 years, visual acuity between 20/200 and 20/40, and no coexisting retinal disease that could affect macular function. Exclusion criteria were the presence of epiretinal membranes and duration of symptoms more than one year. Patients were randomized for surgery with ICG assisted ILM peeling or with application of APC after fluid-gas exchange. The surgical procedure included a standard pars-plana vitrectomy with induction of the posterior vitreous detachment, fluid-gas exchange, and injection of 20% SF6 gas in all patients. Examinations included ETDRS-visual acuity, visual fields and binocular ophthalmoscopy. Examinations were scheduled before surgery, 6 weeks, 6 months and 12 months after surgery. Results: Forty patients (32 female, 8 male) were included into the study. Patients age ranged from 60 to 80 years (mean: 70 ± 6 years). Visual acuity ranged between 20/100 and 20/50 at baseline. At six weeks visual acuity ranged from 20/32 to 20/200. Visual improvement (>2 ETDRS lines) was observed in 40% of eyes after ILM peeling and in 30% of eyes after APC as adjuvant. Anatomic closure was achieved in 80% of eyes after ICG assisted ILM peeling and 70% of eyes after APC by one surgical procedure. Seven eyes underwent successful re-operation. At the last follow-up visit anatomic success was observed in 90% eyes treated with ILM peeling and in 85% treated with APC application. Visual acuity was improved in 45% of eyes after ILM peeling and in 38% of eyes after APC as adjuvant. Complications included retinal pigment epithelial changes (20% in both groups) and development of lens opacities (100% in both groups). Conclusions: Our preliminary results suggest that ILM peeling has advantages in primary anatomical closure rate compared to using APC as adjuvant. The functional outcome showed no significant differences between both treatment groups.
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