#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#
proLékaře.cz / Journals / Czech and Slovak Ophthalmology / 2024 - 4

Outcomes of 25-Gauge Pars Plana Vitrectomy in the Treatment of Idiopathic Macular Hole

Czech version

Authors: Adriana Takáčová 1;  Petra Kéri 1;  Petra Krišková 1;  Nora Majtánová 1,2;  Petr Kolář 1,2
Authors‘ workplace: Očná klinika Slovenskej zdravotníckej univerzity a Univerzitnej nemocnice Bratislava 1;  Lekárska fakulta, Slovenská zdravotnícka univerzita 2
Published in: Čes. a slov. Oftal., 80, 2024, No. 4, p. 1-7
Category: Original Article
doi: https://doi.org/10.31348/2024/20

Overview

Aim: The main aim of this study is to evaluate the anatomical and functional results of pars plana vitrectomy (PPV) with peeling of the internal limiting membrane (ILM), membrane blue staining and subsequent expansile gas tamponade (perfluoropropane) in the treatment of idiopathic macular hole (IMH).

Material and methods: The retrospective analysis consisted of 100 eyes of a total of 100 patients (61 women and 39 men) with IMH, operated on at the Department of Ophthalmology of the Slovak Medical University and University Hospital Bratislava from 1 January 2021 to 1 January 2024, using 25-gauge PPV with ILM peeling and perfluoropropane tamponade (C3F8) of 15% concentration. After surgery, the patients were required to remain in a face-down position for at least one week. Best corrected visual acuity (BCVA), minimal linear diameter (MLD) on optic coherence tomography, macular hole closure type and occurrence of complications were evaluated. The obtained results were expressed with the use of arithmetic averages and displayed in graphs.

Results: Primary closure of macular hole was achieved in 93 patients (93%). The most frequently occurring type of closure was 1A. After surgery, the BCVA of all patients improved, from an average value of 0.101 preoperatively to 0.300 one year after surgery. In all groups of patients (regardless of the size of the macular hole before surgery), during the one-year follow-up period there was a gradual increase in BCVA with its stabilization by 6 months. The main factors that influenced postoperative BCVA were the preoperative values of MLD and BCVA.

Conclusion: PPV with ILM peeling and perfluoropropane tamponade is an effective treatment for idiopathic macular holes with a success rate of more than 90%. This surgical procedure, associated with a relatively low number of complications, brings patients a definite improvement of BCVA.

Keywords:

macular hole – Pars plana vitrectomy – perfluoropropane – ILM peeling

Sources
  1. Steel DH, Donachie PHJ, Aylward GW, Laidlaw DA, Williamson TH, Yorston D; BEAVRS Macular hole outcome group. Factors affecting anatomical and visual outcome after macular hole surgery: findings from a large prospective UK cohort. Eye (Lond). 2021 Jan;35(1):316-325.
  2. Murphy DC, Al-Zubaidy M, Lois N, Scott N, Steel DH; Macular Hole Duration Study Group. The Effect of Macular Hole Duration on Surgical Outcomes: An Individual Participant Data Study of Randomized Controlled Trials. Ophthalmology. 2023 Feb;130(2):152-163.
  3. Duker JS, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013 Dec;120(12):26112619.
  4. Rezende FA, Ferreira BG, Rampakakis E, et al. Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group. Int J Retina Vitreous. 2023 Jan 30;9(1):4.
  5. Machemer R, Buettner H, Norton EW, Parel JM. Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol. 1971 Jul-Aug;75(4):813-820.
  6. Parravano M, Giansanti F, Eandi CM, et al. Vitrectomy for idiopathic macular hole. Cochrane Database Syst Rev. 2015 May 12;2015(5):CD009080.
  7. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002 Oct;109(10):1807-1812. Discussion p.1813.
  8. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005 Feb-Mar;25(2):208-211.
  9. Ye T, Yu JG, Liao L, et al. Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials. BMC Ophthalmol. 2019 Dec 21;19(1):265.
  10. Kolář P. Idiopatická makulární díra – epidemiologie, klasifikace, přirozený průběh, terapie. Praktický lékař. 2005;85(12):697-700.
  11. Rossi T, Bacherini D, Caporossi T, et al. Macular hole closure patterns: an updated classification. Graefes Arch Clin Exp Ophthalmol. 2020 Dec;258(12):2629-2638.
  12. Michalewska Z, Michalewski J, Nawrocki J. Continuous changes in macular morphology after macular hole closure visualized with spectral optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2010 Sep;248(9):1249-1255.
  13. Kim SH, Kim HK, Yang JY, et al. Visual Recovery after Macular Hole Surgery and Related Prognostic Factors. Korean J Ophthalmol. 2018 Apr;32(2):140-146.
  14. Kolář P, Vlková E. Dlouhodobé výsledky chirurgického řešení idiopatické makulární díry s peelingem vnitřní limitující membrány [The Long-Term Results of Surgical Treatment of the Idiopathic Macular Hole with the Peeling of the Internal Limiting Membrane]. : Cesk Slov Oftalmol. 2006;62(1):34-41. Czech.
  15. Hejsek L, Langrová H, Ernest J, Němec P, Rejmont L. Příspěvek k vyšetřování funkce makulární krajiny při chirurgické léčbě idiopatické makulární díry [Contribution to the Investigation Macular Function for the Surgical Treatment of Idiopathic Macular Holes]. Cesk Slov Oftalmol. 2011 Nov-Dec;67(5-6):159-164. Czech.
  16. Veith M, Straňák Z, Penčák M, Studený P. Chirurgické řešení idiopatické makulární díry 25-gauge pars plana vitrektomií s peelingem vnitřní limitující membrány asistované briliantovou modří a plynovou tamponádou [Surgical Treatment of the Idiopathic Macular Hole by Means of 25-Gauge Pars Plana Vitrectomy with the Peeling of the Internal Limiting Membrane Assisted by Brilliant Blue and Gas Tamponade]. Cesk Slov Oftalmol. 2015;71(3):170-174. Czech.
  1. Xu Q, Luan J. Internal limiting membrane flap technique in macular hole surgery. Int J Ophthalmol. 2020 May 18;13(5):822-831.
  2. Kaňovský R, Jurečka T, Gelnarová E. Analýza prognostických faktorů anatomického a funkčního výsledku operace idiopatické makulární díry [Analysis of Prognostic Factors of Anatomical and Functional Results of Idiopathic Macular Hole Surgery]. Cesk Slov Oftalmol. 2009;65(3):91-96. Czech.
Labels
Ophthalmology
The Current State of Artificial Intelligence in Neuro-Ophthalmology. A Review
Association of Fuchs Heterochromic Iridocyclitis with Multiple Sclerosis
Effect of Intravitreal Aflibercept on Corneal Endothelial Cells
Iridocorneal Endothealial Syndrome. Case Reports
Experience with Strabologic Surgery on Pediatric Patients with Divergence Excess Exotropia
Article was published in

Czech and Slovak Ophthalmology

Issue 4
2024 Issue 4
Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#