Author: Andrey Kleymenov (Russian Federation)
Co-authors: Victor Kazaykin
Purpose
To present long-term results of macular hole surgery without vitreous cavity tamponade with gas or another vitreous substitute in post-op period.
Setting/Venue
. IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russia
Methods
Thirty-four eyes of 34 patients were operated on for full-thickness macular holes 100 to 932 (558.5 ±50.9) microns in diameter without vitreous cavity tamponade. BCVA was 0.02 to 0.25 (0.11±0.02). The operation included 3-port 25-27 G vitrectomy, separation of posterior hyaloid. ILM was stained and removed, BSS – air exchange was performed, hole edges were passively pulled towards the center with extrusion cannula and air supply into the vitreous cavity under a pressure of 20-25 mm Hg without mechanical closure. Immediately 0.05 ml of platelet rich plasma (PRP) was applied to macular hole zone. In 2 minutes, fibrin film was formed at the place of application which was pressed to the retina by injection of 0.3 ml of PFCL into the vitreous cavity. PFCL exposure was 5 minutes, then PFCL was passively aspirated with exchange for air. The operation was finished by air exchange for BSS. High specific weight of PFCL facilitated tight adhesion of fibrin film to the retina; due to this the film was attached to the retina during PFCL exchange for air and then for BSS. Follow-up period made from 1 to 20 months (7.9 ± 0.8).
Results
No intraoperative and postoperative complications were seen. In the result of surgery complete closure of the macular hole and anatomical restoration of the macula was achieved in 32 of 34 cases (94.1%). Mean age of the patients was 69±1.2 years (range, 57-84). Mean parameters were: minimum diameter 558.5 ±50.9 µm (range, 100 – 932); base diameter 990 ± 57 µm (range, 599 – 1740 µm; fovea thickness 403±28 µm (range, 300 – 520 µm); parafovea thickness 383±17 µm (range, 338 – 424 µm); macular volume 7.65 ± 0.22 mm³ (range, 7.12 – 8.36 mm³). Thirty patients (88.3%) were phakic. Two eyes (5.8%) had Stage 1 macular holes, one eye (2.9%) had Stage 2 macular hole, five eyes (14.7%) had Stage 3 macular holes, twenty-six eyes (76.4%) had Stage 4 macular holes (Optovue RTVue). First day after surgery IOP was 7 to 15 mm Hg (11 ± 0.46). Postoperative IOP (one year after surgery) was 10 to 20 mm Hg (15 ± 0.78). First day after surgery BCVA was 0.08 to 0.35 (0.2 ± 0.02). Postoperative BCVA (one year after surgery) was 0.3 to 0.7 (0.5±0.05). None of the patients needed cataract surgery at 12-month follow-up (30 patients – 88.3%). Three patients (8.8%) who could get home only by plane flew away at the first day after surgery. A recurrence in two cases was associated with a violation of operation technology when a partial mechanical displacement of the fibrin film with a cannula during PFCL exchange for air occurred.
Conlusions
The suggested method of macular hole surgery without postoperative tamponade of the vitreous cavity with gas or another vitreous substitute may be used in routine clinical practice: the patients get rather high visual acuity at the first day post-op (which is especially important for monocular persons) without face down positioning, reduced risk of cataract and increased IOP, and possibility of air flights and height climbing in the early post-op period
Financial Disclosure
No author has a financial or property interest in any material or method mentioned
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