Changes of Pigment Epithelium after Operation of Idiopathic Macular Holes

Overview

To evaluate changes of the retinal pigment epithelium (RPE) aftersurgery of an idiopathic macular holes (IMD) and their effect on visual acuity.Methods: Fifty eyes of 44 patients with IMD were subjected to pars plana vitrec-tomy, separation of the adhering cores of the vitreous body and IMD tamponadewith 16% C 3 F 8. In 32 eyes autologous thrombocyte concentrate (AKT) was admi-nistered, during the initial operation in 23 eyes and during re-operation in 9 eyes.The patients were followed up for 6-28 months (average 15 months).Changes of RPE were evaluated by biomicroscopy and fluoroangiography.Results: Changes of RPE were observed in 18 eyes (36 %). In this group visualacuity improved in 11 eyes (61 %) and the final mean visual acuity was 0.41.Facet-like foci characterized by minor defects and/or hyperplasia of RPE werefound in 27 eyes (54%). In this group visual acuity improved in 19 eyes (70 %) andthe final visual acuity, 0.22, and the mean difference between pre- and postopera-tive visual acuity were significantly worse than in the eyes without new changesof RPE (p = 0.0108, and 0.0470 resp.).Disciform (phototoxic) lesions in the maculadeveloped in five eyes (10 %) and were manifested by gross spotty changes of RPEon fluoroangiograms, as a rule by early hypofluorescence and late subretinalstaining. Visual acuity improved slightly on one eye (20 %). AKT did not affectchanges of RPE.Conclusions: Changes of RPE after operation of IMD are frequent and maysignificantly reduce the postoperative visual acuity. Administration of AKT du-ring surgery does not influence the incidence of RPE changes. RPE changes areprobably caused by surgical trauma of a compromised macula.

Key words:
idiopathic macular hole, pars plana vitrectomy, retinal pigment