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Christian Pruente; Radial foveal incisions as a surgical technique for persistent macula holes. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5789.
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© ARVO (1962-2015); The Authors (2016-present)
Various surgical techniques have been described for managing persistent macula holes following unsuccessful vitrectomy with ILM peeling. However the closure rate and functional improvement after these procedures are limited. Therefore a new technique, performing radial retinal incisions (retinotomies) was performed in eyes with large persistent macula holes despite previous vitrectomy and ILM peeling.
In a retrospective consecutive case series the closure rate and Snellen visual acuity was evaluated in 18 eyes of 18 patients with persistent macular hole where small incision re-vitrectomy with radial retinal incisions (retinotomies) and air-tamponade was performed as a second procedure. The primary unsuccessful intervention included vitrectomy, detachment of the posterior vitreous, ILM peeling and air tamponade with face-down positioning. For all eyes Snellen BCVA, biomicroscopic fundus evaluation and OCT examination were evaluated before and 6 to 24 months after re-vitrectomy.
At baseline the mean macula hole diameter was 663±102 μm. At the final examination 14 of 18 macula holes (78%) were closed. Visual acuity increased in 13 eyes, was stable in 3 eyes (2 without macula hole closure) and declined in 2 eyes, both without macular hole closure. Mean BCVA increased from Snellen 0.10±0.05 at baseline to 0.32±0.15 (logMar 1.02±0.21 to 0.56±0.28). In all successful cases macula hole closure was observed after 3 days and no eye showed recurrence of a macula hole.
These results in a limited case series suggest that radial retinal incisions of the rim in persistent macula holes after initial surgery including ILM peeling increases the success-rate for macula hole closure and results in relevant increase in BCVA. However, as the number of eyes in this series is limited the result has to be confirmed in a larger population.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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