Tommaso Rossi1, Carlandrea Trillo2, Herman D Schubert3, Serena Telani2, Paola Cirafici2, Daniele Ferrari2, Guido Ripandelli4. 1. IRCCS Ospedale Policlinico San Martino, UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy. tommaso.rossi@usa.net. 2. IRCCS Ospedale Policlinico San Martino, UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy. 3. Edward Harkness Eye Institute, Columbia Presbyterian Medical Center, Columbia University, New York, NY, USA. 4. IRCCS G.B. Bietti Foundation ONLUS, Rome, Italy.
Abstract
PURPOSE: The purpose of the present paper is to describe a surgical technique aimed at creating multiple layers of Internal Limiting Membrane (ILM) using Perfluorocarbon Liquid (PFCL) in order to favour the closure of large, chronic and myopic Macular Holes (MH). METHODS: Thirty patients belonging to 3 subgroups: large (> 500 μm), chronic (> 12 months) and myopic (> - 9 diopters), MHs, underwent surgery and completed 6 months follow-up. The ILM was engaged and peeled 360° around the MH, hinged to the rim and folded over the hole. A PFCL bubble spanning the vascular arcades was then injected and the ILM is grasped repeatedly to fold the distal edge towards the MH centre, creating multiple ILM layers over the MH. RESULTS: MH closed in 26/30 cases (86.6%) with no significant difference among subgroups. Vision improved 2.57 ± 1.56 Snellen lines from LogMAR 1.50 ± 1.19 to 1.19 ± 1.32 (p < 0.01). Ellipsoid Zone (EZ) interruption width reduced from 1129 ± 439 μm to 258 ± 507 μm (p < 0.001) and correlated to pattern of MH closure, post-BCVA and line improvement (p < 0.001 in all cases). DISCUSSION: The use PFCL allows multiple ILM layers and resulted in a high closure rate. Pattern of MH closure differs from those previously described leaving a plug of ILM tissue that interrupts retinal architecture often only in the inner layers. PFCL gravity and hydrophobicity displace aqueous while the intensely polar opposite faces of the ILM attract each other. The folded ILM plugs MH and bridges the gap and may help glial cell proliferation and migration.
PURPOSE: The purpose of the present paper is to describe a surgical technique aimed at creating multiple layers of Internal Limiting Membrane (ILM) using Perfluorocarbon Liquid (PFCL) in order to favour the closure of large, chronic and myopic Macular Holes (MH). METHODS: Thirty patients belonging to 3 subgroups: large (> 500 μm), chronic (> 12 months) and myopic (> - 9 diopters), MHs, underwent surgery and completed 6 months follow-up. The ILM was engaged and peeled 360° around the MH, hinged to the rim and folded over the hole. A PFCL bubble spanning the vascular arcades was then injected and the ILM is grasped repeatedly to fold the distal edge towards the MH centre, creating multiple ILM layers over the MH. RESULTS: MH closed in 26/30 cases (86.6%) with no significant difference among subgroups. Vision improved 2.57 ± 1.56 Snellen lines from LogMAR 1.50 ± 1.19 to 1.19 ± 1.32 (p < 0.01). Ellipsoid Zone (EZ) interruption width reduced from 1129 ± 439 μm to 258 ± 507 μm (p < 0.001) and correlated to pattern of MH closure, post-BCVA and line improvement (p < 0.001 in all cases). DISCUSSION: The use PFCL allows multiple ILM layers and resulted in a high closure rate. Pattern of MH closure differs from those previously described leaving a plug of ILM tissue that interrupts retinal architecture often only in the inner layers. PFCL gravity and hydrophobicity displace aqueous while the intensely polar opposite faces of the ILM attract each other. The folded ILM plugs MH and bridges the gap and may help glial cell proliferation and migration.
Authors: Fernando José De Novelli; Rony Carlos Preti; Mario Luiz Ribeiro Monteiro; David E Pelayes; Mario Junqueira Nóbrega; Walter Yukihiko Takahashi Journal: Ophthalmic Res Date: 2015-11-17 Impact factor: 2.892