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Christopher Robert Adam, Eric J. Sigler, John C. Randolph, Jorge I. Calzada; Longitudinal analysis of foveal microstructure following arcuate retinotomy for chronic large macular holes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5013. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
There are currently limited surgical techniques available for primary treatment of chronic very large full thickness macular holes (FTMH). Success rates for anatomical macular hole closure and improved visual function with traditional techniques are variable with many patients after surgical failure deemed inoperable. To further characterize the surgical technique, foveal microstructure analysis, and assess visual outcomes of chronic very large macular holes following primary full thickness arcuate retinotomy (AR).
Longitudinal, retrospective observational clinical study. This study included 1 eye of 10 patients with a chronic idiopathic FTMH of base diameter greater than 800 µm (very large macular hole) by optical coherence tomography (OCT). A full thickness relaxing incision was made 250 µm from the temporal edge of the FTHM in the longitudinal plane centered around the temporal horizontal meridian with an arc length of 100 degrees along with a 25 gauge pars plana vitrectomy, internal limiting membrane peel, and fluid-gas exchange. Outcome measures included preoperative and postoperative best corrected distance visual acuity (BCVA) and anatomical macular hole closure rate with analysis of foveal microstructure.
Mean macular hole chronicity prior to AR was 3 years. Preoperative mean macular hole base diameter was 1,200 µm (range, 800-2000 µm). Mean type 1 closure was achieved in 7 (70%) of 10 subjects by postoperative week 3. Mean AR site was sealed by postoperative week 1. Mean preoperative BCVA was 20/400. Mean final BCVA was 20/100 on postoperative month 6. No postoperative complications related to the surgical procedure were noted.
AR is a recently described surgical procedure typically reserved for reoperation after failed closure of large macular holes. We further characterize the surgical technique of performing a full thickness AR for the primary treatment of chronic very large macular holes. We have demonstrated both anatomic closure success by OCT analysis and promising visual outcomes with this novel method. An arcuate retinotomy may be considered as a primary treatment option in select cases over traditional methods which challenges the current understanding and treatment of chronic very large macular holes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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