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Hardik A Parikh, Rebecca Liebenthal, Akash Gupta, Joseph Tseng, Kenneth Wald; Characterization of Outcomes for Re-Operation in Macular Hole Surgery Using Inner Retinal Brushing. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1080.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize outcomes for patients with re-operated macular holes using a novel technique after failed closure in the initial surgery
A retrospective chart review was conducted on 401 eyes that had undergone macular hole surgery in a private retina practice from 2013 to 2018. Those patients that underwent re-operation for persistently open macular hole were then identified. The initial macular hole surgery was done using pars plana vitrectomy (PPV), hyaloid elevation, internal limiting membrane (ILM) peeling with indocyanine green staining (ICG) with wide removal to the arcades, SF6 gas, and prone positioning for 6 days. For those patients that underwent a successive operation, 25-gauge PPV and a Tano diamond-dusted membrane scraper or Finesse flex loop was used to brush the retina in an outside-in manner in attempts to reduce the hole diameter. No attempt was made to restain the ILM, and C3F8 gas was used for re-operation. Age, race, gender, lens status, initial visual acuities before initial surgery, time to reoperation, and final visual outcomes were recorded. The optical coherence tomography (OCT) images of the initial hole and re-operated hole were analyzed.
Eight eyes were re-operated from 2013 2018. Visual outcomes improved by at least 3 lines from the initial prior to surgery to the most recent following re-operation in 7 (87.5%) patients, with all 8 (100%) eyes having macular hole closure. The re-operated eyes had larger hole diameters of >500 microns compared to eyes with successful primary macular hole operation.
Previous studies have reported few techniques for re-operation include wider ILM peel/rexis and intraoperative macular hole fluid drainage. In this study, we utilized a technique of brushing the retina in an outside-in manner to help facilitate anatomic closure of the hole. Inner retinal brushing with hole diameter reduction and long-acting gas appears to be a successful treatment for persistent macular holes or possibly as initial surgery for large macular holes.
This is a 2020 ARVO Annual Meeting abstract.
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