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 Aspiration of viscous plug in macular hole surgery- a case series

2022 ◽  
Vol 14 ◽  
pp. 251584142110632
Author(s):  
Shaheryar Ahmed Khan ◽  
Craig Goldsmith ◽  
Mya Thandar So
Keyword(s):  
Viscous Fluid ◽  
Macular Hole ◽  
Controlled Trial ◽  
Standard Procedure ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Control Group ◽  
Macular Hole Surgery ◽  
Gas Tamponade ◽  
Hole Closure

Macular hole surgery has been revolutionized since the 1990s’ with the advent of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade, which is now extensively practiced and regarded as the gold standard procedure for surgical treatment of macular hole. Here, we report a simple adjunctive maneuver to conventional PPV with ILM peel and gas tamponade. We observed presence of a viscous fluid in the base of the macular hole in our series. In all, 40 eyes of 39 patients consecutively operated on from June 2019 to December 2020 for PPV with ILM peel and gas tamponade, were included in this study. The viscous plug was aspirated passively using a 25 gauge cannula with its tip above the macular hole, approaching only until a fluid-wave was visualized, which resulted in flattening of the fluid cuff area aiding the macular hole closure in a concentric pattern. Macular hole closure and complete success was seen in 39 out of 40 eyes (97.5%) and only 1 failure (2.5%) observed in this series. In our case series, we have observed the presence of a viscous fluid plug in the macular hole. We demonstrated that aspirating this thick fluid from the hole results in the flattening of the cuff of fluid and subsequent closure of the macular hole in a concentric manner in almost all cases in our series. The lack of concurrent control group means we cannot state a definitive effect of the intervention, but it does suggest the utility of a prospective randomized controlled trial.

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

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.

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.

scholarly journals Comparative Study between Pars Plana Vitrectomy with Internal Limiting Membrane Peel and Pars Plana Vitrectomy with Internal Limiting Membrane Flap Technique for Management of Traumatic Full Thickness Macular Holes

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Hammouda Hamdy Ghoraba ◽  
Mahmoud Leila ◽  
Hashem Ghoraba ◽  
Mohamed Amin Heikal ◽  
Emad Eldin Mohamed Elgemai
Keyword(s):  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Closure Rate ◽  
Bivariate Correlation ◽  
Group I ◽  
Macular Holes ◽  
Pars Plana ◽  
Group Ii

Purpose. To compare the efficacy of PPV and ILM peel versus PPV and IFT in patients with traumatic FTMH. Methods. Retrospective interventional comparative case series including two groups of patients with traumatic FTMH. Patients were divided into group I (ILM peel) and group II (IFT). The main outcome measure was closure of the macular hole and restoration of the foveal microstructure. The independent-samples T-test and ANOVA test were used to study the mean between 2 groups and calculate the P value, whereas the bivariate correlation procedure studied the interaction between the variables tested. Results. Group I included 28 patients. Mean preoperative MLD was 757 µm. Mean preoperative BCVA was approximately 20/320. Group II included 12 patients. Mean preoperative MLD was 529.5 µm. Mean preoperative BCVA was 20/320. Group I had a macular hole closure rate of 75% versus 92% in group II P=0.05. Mean BCVA improvement was 2.5 lines in group I versus 5 lines in group II P=0.02. Disrupted ELM and IS/OS was the most salient finding in both groups. Conclusion. IFT has a significantly superior anatomic and functional outcome compared to ILM peel in traumatic FTMH.

scholarly journals Macular Hole Surgery with Internal Limiting Membrane Peeling Facilitated by Membrane-Blue® versus Membrane-Blue-Dual®: A Retrospective Comparative Study

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Uri Soiberman ◽  
Daniel Shai ◽  
Anat Loewenstein ◽  
Adiel Barak
Keyword(s):  
Macular Hole ◽  
Retrospective Chart Review ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Study Population ◽  
Pars Plana ◽  
Retrospective Comparative Study ◽  
Visual Results ◽  
Hole Closure

Background. This study aims to compare the outcome of macular hole (MH) surgery with internal limiting membrane (ILM) peeling facilitated by two different vital dyes. Methods. This was a retrospective chart review. The group designated “group-MB” underwent pars plana vitrectomy with ILM peeling facilitated by Membrane-Blue (MB), whereas in “group-MBD,” the vital dye used was Membrane-Blue-Dual (MBD). Results. Seventy-four eyes comprised the study population: 53 in group-MB and 21 in group-MBD. There was no difference in the rate of macular hole closure in group-MB or group-MBD: 71.2% closed MHs compared to 66.7%, respectively (p=0.7). Postoperative visual improvement was of a higher magnitude in the MBD group compared to the MB group: −0.34±0.81 logMAR versus 0.01±0.06 logMAR, respectively (p=0.003). Conclusions. In this study, MBD led to better visual results that may be related to better staining characteristics or lesser toxicity compared to MB.

scholarly journals An Internal Limiting Membrane Plug and Gas Endotamponade for Recurrent or Persistent Macular Hole

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Fabrizio Giansanti ◽  
Ruggero Tartaro ◽  
Tomaso Caporossi ◽  
Daniela Bacherini ◽  
Alfonso Savastano ◽  
...  
Keyword(s):  
Macular Hole ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Swept Source ◽  
Macular Holes ◽  
Small Gauge ◽  
Pars Plana ◽  
The Mean ◽  
23 Gauge ◽  
Anatomical Success

Introduction. Recurrent or persistent macular holes (MHs) are rare today due to the tendency to carefully peel the internal limiting membrane. Conversely, their treatment is still a challenge for a vitreoretinal surgeon. Materials and Methods. This is a retrospective, consecutive, and nonrandomized study of patients affected by recurrent or persistent MHs treated using small-gauge pars plana vitrectomy (25- or 23-gauge) and an autologous ILM plug, at the Eye Clinic of Azienda Ospedaliera Universitaria Careggi (Florence, Italy) between January 2016 and May 2018. We included 8 eyes of 8 patients in the study. Five patients had a recurrent MH while 3 had a persistent MH. The case series includes patients with myopic eyes and with large macular holes (>400 μ). Patients were followed up with ophthalmoscopic examinations and swept-source optical coherence tomography (SS-OCT). Results. The mean age of the patients was 74 years (±4.81 standard deviation (SD)), 3 patients were men and 5 women. The average axial length was 26.28 mm (±2.84 SD). Four patients had an AL ≧ 26 mm. The mean MH diameter was 436.5 (±49.82 SD). Average preoperative best-corrected visual acuity (BCVA) was 0.81 logMAR (±0.16 SD) and 20/125 Snellen. The ILM plug has been found integrated in the MH in all the follow-ups. Conclusion. In our study, an ILM autologous macular transplant was used successfully in 5 cases of macular hole recurrence and 3 cases of macular hole persistence. The anatomical success was achieved in all the cases; 4 patients improved their BCVA, and 4 patients maintained it. No macular alterations such as RPE or retinal atrophy/dystrophy were observed after 6 months.

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