Carsten H Meyer1, Peter Szurman2, Christos Haritoglou3,4, Mathias Maier5, Armin Wolf4, Lyubomyr Lytvynchuk6, Siegfried Priglinger4, Jost Hillenkamp7, Joachim Wachtlin8,9, Matthias Becker10, Stefan Mennel11, Michael J Koss3. 1. Augenärzte Kammanneye, Davos, Switzerland. meyer_eye@yahoo.com. 2. Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany. 3. Department of Ophthalmology, Herzog Carl Theodor Eye Clinic, Munich, Germany. 4. Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany. 5. Department of Ophthalmology, Technical University of Munich, Munich, Germany. 6. Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany. 7. Department of Ophthalmology, University Würzburg, Würzburg, Germany. 8. Department of Ophthalmology, Sankt Gertrauden Krankenhaus, Berlin, Germany. 9. MHB Midizinische Hochschule Brandenburg, Neuruppin, Germany. 10. Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland. 11. Department of Ophthalmology, Feldkirch State Hospital, Feldkirch, Austria.
Abstract
INTRODUCTION: Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. METHODS: Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. RESULTS: The mean duration of the MH prior to SR-fluid application was 17 months (6-96 months). The mean age of the patients at the time of surgery was 72 years (54-88). The mean preoperative aperture diameter of the opening was 1212 μm (239-4344 μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01-0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02-0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. CONCLUSION: Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.
INTRODUCTION: Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. METHODS: Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. RESULTS: The mean duration of the MH prior to SR-fluid application was 17 months (6-96 months). The mean age of the patients at the time of surgery was 72 years (54-88). The mean preoperative aperture diameter of the opening was 1212 μm (239-4344 μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01-0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02-0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. CONCLUSION: Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.
Entities:
Keywords:
Large aperture; Macular hole; Retreatment; Subretinal fluid; Vitrectomy; Vitreoretinal surgery
Authors: Gavin S W Tan; Zengping Liu; Tanja Ilmarinen; Veluchamy A Barathi; Caroline K Chee; Gopal Lingam; Xinyi Su; Boris V Stanzel Journal: Transl Vis Sci Technol Date: 2021-01-07 Impact factor: 3.283