Air vs Gas Tamponade During Macular Hole Repair Surgery

2020 ◽  
Vol 4 (5) ◽  
pp. 360-363
Author(s):  
Shriji N. Patel ◽  
Janice Law ◽  
Edward Cherney ◽  
Franco Recchia ◽  
Stephen J. Kim
Keyword(s):  
Macular Hole ◽  
Sulfur Hexafluoride ◽  
Final Analysis ◽  
Gas Tamponade ◽  
Macular Holes ◽  
Full Thickness Macular Hole ◽  
Significant Difference ◽  
Pars Plana ◽  
Operative Report ◽  
Hole Closure

Purpose: This work investigates the visual and anatomical outcomes of full-thickness macular hole (FTMH) repair surgery using air in comparison to gas tamponade. Methods: A retrospective consecutive review of medical records was undertaken of all patients undergoing pars plana vitrectomy for idiopathic FTMH at an academic practice from January 2010 to May 2017. Each operative report was reviewed to investigate the agent used for tamponade at the end of the surgery. Preoperative hole duration and size as measured using optical coherence tomography as well as successful postoperative hole closure were recorded. Use of gas or air was not randomized and was instilled at surgeon discretion. Results: The final analysis included 211 eyes. Gas was used as the tamponade agent in 171 of the 211 eyes; most of these eyes (144 of 171) received sulfur hexafluoride (SF6) and the remainder received perfluoropropane (C3F8). Forty eyes underwent only a complete fluid-air exchange without any gas placement following vitrectomy. There was no statistically significant difference between the 2 groups in mean preoperative macular hole size ( P = .43). Nine of the 171 macular holes receiving gas tamponade failed to close (5.3%). One of the 40 macular holes receiving only air failed to close (2.5%). There was no statistically significant difference in hole closure rates between the 2 groups ( P = .45). Conclusions: Air served as an equally efficacious internal tamponade agent in comparison to nonexpansile gas following idiopathic FTMH repair surgery.

scholarly journals Role of intraretinal cysts in the prediction of postoperative closure and photoreceptor damages of the idiopathic full-thickness macular hole

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jin-Ho Joo ◽  
Woo Ho Nam ◽  
Taesung Joo ◽  
Sang Woong Moon
Keyword(s):  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Full Thickness ◽  
Base Diameter ◽  
Full Thickness Macular Hole ◽  
Significant Difference ◽  
Two Factors ◽  
Pars Plana ◽  
Hole Closure

Abstract Background To determine whether it would be effective in predicting the results of the postoperative full-thickness macular hole (FTMH) closure when intraretinal cyst (IRC) is present. Methods Case-control study. Patients with idiopathic FTMH who underwent pars plana vitrectomy with internal limiting membrane peeling were retrospectively reviewed. Preoperative spectral-domain optical coherence tomography was undertaken in all patients. The new parameter, macular hole closing factor (MHCF) was defined as the base diameter - (arm length + IRC height) by adding IRC to the existing parameter. After surgery, patients were classified and analyzed according to the type of hole closure and the damage of photoreceptor. Results Of the 35 patients, 28 (80.00%) had type 1 closure and seven (20.00%) had type 2 closure. There was a significant difference in postoperative BCVA (P < 0.01), base diameter (P = 0.037), arm length (P = 0.045), and IRC height (P = 0.011) between the two groups. In the type 1 closure, they were further divided into two subgroups according to photoreceptor damage, and it was confirmed that there were significant differences in postoperative BCVA (P = 0.045), hole height (P = 0.048), and IRC height (P = 0.046) in the two subgroups. As for the new parameters, a significant difference between the three groups was confirmed (P < 0.01). Conclusion IRC may help predict hole closure along with the known horizontal parameters. Therefore, the new parameter containing both two factors can help predict not only hole closure but also damage to photoreceptors that affects postoperative visual prognosis.

scholarly journals The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

2016 ◽  
Vol 7 (6) ◽  
pp. 43-46
Author(s):  
Lalit Agarwal ◽  
Nisha Agrawal ◽  
Pratap Karki ◽  
Abhishek Anand
Keyword(s):  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Chronic Stage ◽  
Visual Improvement ◽  
Macular Holes ◽  
Pars Plana ◽  
Hole Closure

Background:  A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm.Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole.Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1st January 2013 to 30th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated.Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p<0.001). Visual improvement was seen in only eight (53.3%) eyes. Both macular hole closure and visual improvement showed no correlation with minimum linear diameter, base diameter and hole height.Conclusion: Chronic stage 3 macular hole can be closed successfully in majority of patients with fairly good visual improvement. Macular hole parameters of stage 3 holes may not have any correlation with the anatomical and visual outcome.Asian Journal of Medical Sciences Vol.7(6) 2016 43-46

Surgical Macular Hole Closure Without a Gas Tamponade

2021 ◽  
pp. 247412642110189
Author(s):  
Scott Grant ◽  
Sean D. Adrean
Keyword(s):  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Gas Bubble ◽  
Hole Size ◽  
Gas Tamponade ◽  
Pars Plana ◽  
Visual Results ◽  
Hole Closure

Purpose: This work aims to evaluate the outcomes of a series of macular hole (MH) surgical procedures in patients who had pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peel and without gas tamponade. Methods: Patients from a retina specialty clinic who had MHs were identified for this interventional case series. Patients with small MHs were offered inclusion into the trial. Patients with larger MHs were excluded. They underwent standard 3-port PPV and ILM peel without gas or air to treat small MHs. The main outcomes that we measured were closure of MH and visual results. Results: Small MHs in 5 patients were managed with PPV and ILM peel alone. The average preoperative hole size at its narrowest width was 227 µm (range, 173-294 µm). Four of 5 patients (80%) had successful hole closure without a gas tamponade and improved vision; 1 patient did not have hole closure and was treated with an in-office gas bubble to close the hole. The average preoperative vision at 3 months was 20/80– (54 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and improved to 20/30–2 (73 ETDRS letters) in the 4 patients whose MHs were closed with surgery without a gas bubble. This was statistically significant ( P = .003). The hole that did not close initially without gas tamponade was the largest in the series. Conclusions: Patients with small MHs can be successfully treated with a vitrectomy and ILM peel alone without a gas tamponade.

scholarly journals Autologous Platelet-Rich Fibrin in the Treatment of Refractory Macular Holes

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Arif Koytak ◽  
Fadime Nuhoglu ◽  
Havvanur Bayraktar ◽  
Rukiye Ercan ◽  
Hakan Ozdemir
Keyword(s):  
Macular Hole ◽  
Sulfur Hexafluoride ◽  
Case Reports ◽  
Effective Alternative ◽  
Platelet Rich Fibrin ◽  
Gas Tamponade ◽  
First Case ◽  
Macular Holes ◽  
Novel Method ◽  
Autologous Platelet

Purpose. To describe a novel method for the treatment of refractory macular holes. Methods. Two case reports on the use of autologous platelet rich fibrin (PRF), followed by sulfur hexafluoride gas tamponade to facilitate closure of refractory macular holes. Results. Macular holes were succesfully closed within a week in both cases. Best corrected Snellen visual acuities improved from counting fingers to 0.16 in the first case, and from 0.05 to 0.2 in the second case. No complication occurred during or after the procedures. Conclusion. The use of autologous PRF seems to be a safe and effective alternative method for the treatment of refractory macular holes. Further experience and studies are required to assess the value of autologous PRF in the management of challenging macular hole cases of different etiologies. To the best of our knowledge, this is the first use of autologous PRF in the treatment of macular holes.

Internal limiting membrane flap transposition for surgical repair of macular holes in primary surgery and in persistent macular holes

2017 ◽  
Vol 28 (2) ◽  
pp. 225-228 ◽  
Author(s):  
Christoph Leisser ◽  
Nino Hirnschall ◽  
Birgit Döller ◽  
Ralph Varsits ◽  
Marlies Ullrich ◽  
...  
Keyword(s):  
Macular Hole ◽  
Surgical Repair ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Gas Tamponade ◽  
Primary Surgery ◽  
Macular Holes ◽  
Prospective Case Series ◽  
Hole Closure

Purpose: Classical or temporal internal limiting membrane (ILM) flap transposition with air or gas tamponade are current trends with the potential to improve surgical results, especially in cases with large macular holes. Methods: A prospective case series included patients with idiopathic macular holes or persistent macular holes after 23-G pars plana vitrectomy (PPV) and ILM peeling with gas tamponade. In all patients, 23-G PPV and ILM peeling with ILM flap transposition with gas tamponade and postoperative face-down position was performed. Results: In 7 of 9 eyes, temporal ILM flap transposition combined with pedicle ILM flap could be successfully performed and macular holes were closed in all eyes after surgery. The remaining 2 eyes were converted to pedicle ILM flap transposition with macular hole closure after surgery. Three eyes were scheduled as pedicle ILM flap transposition due to previous ILM peeling. In 2 of these eyes, the macular hole could be closed with pedicle ILM flap transposition. In 3 eyes, free ILM flap transposition was performed and in 2 of these eyes macular hole could be closed after surgery, whereas in 1 eye a second surgery, performed as pedicle ILM flap transposition, was performed and led to successful macular hole closure. Conclusions: Use of ILM flaps in surgical repair of macular hole surgery is a new option of treatment with excellent results independent of the diameter of macular holes. For patients with persistent macular holes, pedicle ILM flap transposition or free ILM flap transposition are surgical options.

scholarly journals Posterior pole retinotomy for treatment of recurrent macular hole retinal detachment in highly myopic eyes: a pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xianggui Wang ◽  
Xuezhi Zhou ◽  
Ying Zhu ◽  
Huizhuo Xu
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Posterior Pole ◽  
Macular Holes ◽  
Macular Hole Retinal Detachment ◽  
Pars Plana ◽  
Silicone Oil Tamponade ◽  
Hole Closure

Abstract Background To investigate the feasibility and efficacy of posterior pole retinotomy to treat recurrent macular hole retinal detachment (MHRD) in highly myopic patients. Methods We performed a retrospective study and reviewed the medical records in our hospital between January 1, 2016 and December 31, 2018. Highly myopic patients who received posterior pole retinotomy with silicone oil tamponade for their recurrent MHRD after pars plana vitrectomy were included in the analysis. Postoperative retinal reattachment, best-corrected visual acuity (BCVA), macular hole closure, and complications were evaluated. Results There were 11 patients (11 eyes) included in this study. All retinas were reattached. Silicone oil was successfully removed from all eyes 1.5–3 months after the surgery. Macular holes were completely closed in three eyes and remained flat open in eight eyes. The BCVA of all eyes improved significantly at 12 months after surgery (logarithm of the minimal angle of resolution, pre vs. postoperatively, 1.87 ± 0.44 vs. 1.15 ± 0.24, P < 0.05). None of the patients had complications such as endophthalmitis, fundus hemorrhage, retinal redetachment, and proliferative vitreoretinopathy. Conclusion Posterior pole retinotomy is a safe and effective surgery to treat recurrent MHRD after pars plana vitrectomy in highly myopic patients.

Pars plana vitrectomy with silicone oil tamponade for primary and secondary macular hole closure: Is it still a useful procedure?

2018 ◽  
Vol 28 (5) ◽  
pp. 503-514 ◽  
Author(s):  
Janusz Pieczynski ◽  
Patrycja Kuklo ◽  
Andrzej Grzybowski
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Surgical Techniques ◽  
Successful Outcome ◽  
Gas Tamponade ◽  
Pars Plana ◽  
Silicone Oil Tamponade ◽  
Hole Closure

Purpose: To evaluate usefulness of posterior vitrectomy with silicone oil tamponade for primary and secondary macular hole closure. Methods: We searched for publications on the surgical treatment of full-thickness idiopathic and recurrent macular hole. We divided reports into two groups: primary macular hole repair and recurrent macular hole repair with silicone oil tamponade. Results: In primary macular hole treatment, different authors confirmed effectiveness of silicone oil tamponade. They suggest that the most important factor for successful outcome was completeness of vitreous cavity filling with oil. Complications after this method were comparable to those after gas tamponade. However, even if good anatomical results are achieved in secondary macular hole closure, visual acuity is sometimes less rewarding. Conclusion: There are reports on good efficacy of silicone oil tamponade for primary and recurrent macular hole closure. Anatomical closure and visual acuity rates in pars plana vitrectomy with silicone oil and with gas filling are comparable. Gas tamponade seems to be safer and needs no more surgery. Postoperative complications in both methods are similar, but all patients with silicone oil filling need to undergo a reoperation to have the silicone removed. There are also other surgical techniques for primary macular hole closure as well as for unsuccessful primary macular hole procedures. We think that primary macular hole closure should be performed with gas tamponade, supported with different adjuvants, as a method of choice. Silicone oil tamponade could be still an alternative in cases, when there are no more efficient techniques or possibilities to treat with success recurrent macular hole.

Outcome of autologous platelet concentrate and gas tamponade compared to heavy silicone oil tamponade in persistent macular hole surgery

2020 ◽  
pp. 112067212090370 ◽  
Author(s):  
Friederike Schaub ◽  
Nasir Gözlügöl ◽  
Corinna von Goscinski ◽  
Philip Enders ◽  
Ludwig M Heindl ◽  
...  
Keyword(s):  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Sulfur Hexafluoride ◽  
Silicone Oil ◽  
Platelet Concentrate ◽  
Heavy Silicone Oil ◽  
Autologous Platelet Concentrate ◽  
Pars Plana ◽  
Autologous Platelet ◽  
Hole Closure

Purpose: Persistence represents the major reason for failure of primary macular hole repair. A variety of surgical approaches are available for treating persistent macular holes. To compare clinical outcome of re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20% gas tamponade with heavy silicone oil in persistent macular hole. Methods: Records of 48 consecutive eyes with persistent macular holes which underwent re-pars plana vitrectomy with either heavy silicone oil (35 eyes, persistent macular–hole minimum linear diameter: 518.8 ± 171.1 µm) or autologous platelet concentrate and sulfur hexafluoride 20% (13 eyes, persistent macular hole–minimum linear diameter: 454.1 ± 211.3 µm) were reviewed retrospectively. All patients underwent measurements of anatomical persistent macular hole characteristics evaluated by optical coherence tomography and visual function. Cases in which anatomical success failed after first re-pars plana vitrectomy were treated with the other surgical techniques, comparable to a cross-over design. Results: Persistent macular hole closure rate was 57.1% with autologous platelet concentrate and sulfur hexafluoride 20% and 45.7% with heavy silicone oil ( p = 0.102). Functional results were comparable when persistent macular hole closure was achieved ( p ⩾ 0.741), but significantly better for the autologous platelet concentrate with sulfur hexafluoride 20% group when persistent macular hole closure failed ( p = 0.019). Conclusion: Re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20% seems to achieve at least non-inferior persistent macular hole closure rates and comparable functional results when compared to heavy silicone oil, suggesting autologous platelet concentrate and sulfur hexafluoride 20% as a safe surgical alternative in persistent macular hole. Especially when persistent macular hole closure failed, autologous platelet concentrate with sulfur hexafluoride 20% seems to be superior regarding visual outcome.

scholarly journals Recurrent Macular Hole: Causes, Risk Factors, and Treatment

2018 ◽  
pp. 293-295
Keyword(s):  
Risk Factors ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Retinal Breaks ◽  
Head Positioning ◽  
Pars Plana ◽  
Risk Factors For Recurrence ◽  
Hole Closure

Idiopathic macular hole is a full-thickness defect of the retina which is caused by the tangential vitreomacular traction. Its prevalence is 8.7 per 100,000 people. Pars plana vitrectomy, internal limiting membrane peeling, gas tamponade, and face-down head positioning have a high success rate for primary hole closure. Improvements in small incision vitrectomy techniques reduce cystoid macular edema, epiretinal membrane formation, and also reopening of macular hole. Bilaterality, high myopia, intraoperative retinal breaks are well-known risk factors for recurrence. In this article, we reviewed the causes, risk factors, and current treatments of recurrent macular holes.

scholarly journals Development of Stage 4 Macular Hole after Spontaneous Closure in a Patient with Stage 2 Macular Hole and a Lamellar Macular Hole-Associated Epiretinal Proliferation

2021 ◽  
pp. 481-484
Author(s):  
Masahisa Watanabe ◽  
Harumasa Yokota ◽  
Hiroshi Aso ◽  
Hirotsugu Hanazaki ◽  
Junya Hanaguri ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Spontaneous Closure ◽  
Surgical Removal ◽  
Lamellar Macular Hole ◽  
Full Thickness ◽  
Stage 4 ◽  
Full Thickness Macular Hole ◽  
The Right ◽  
Hole Closure

Herein, we report the longitudinal observation of a case with reopening of the macular hole associated with a lamellar macular hole-associated epiretinal proliferation (LHEP) followed by spontaneous closure in patients with stage 2 idiopathic macular hole. A 64-year-old woman was referred for the decreased visual acuity (VA) and acute anorthopia in the right eye. Funduscopy and optical coherence tomography (OCT) showed stage 2 full-thickness macular hole without posterior vitreous detachment (PVD) and operculum formation. Her best-corrected visual acuity (BCVA) was 20/32. One month later, the diameter of the macular hole was getting small and VA improved. Six months later, the macular hole was treated spontaneously with the attached hyaloid membrane to the macula by OCT and the BCVA improved to 20/20. Fourteen months after the first visit, the BCVA decreased to 20/50 and the patient was diagnosed with stage 4 macular hole with complete PVD. OCT showed full-thickness macular hole with a LHEP in the right eye. After 25G-gauge vitrectomy with the peeling of internal limiting membrane (ILM) and LHEP, the macular hole was closed and BCVA finally improved to 20/25. Spontaneous macular hole closure without PVD may rarely occur in patients with LHEP. The surgical removal of ILM and LHEP may contribute to the successful macular hole closure after vitrectomy.

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