Lyubomyr M Lytvynchuk1,2, Andrii Ruban3, Carsten Meyer4, Knut Stieger5, Andrzej Grzybowski6,7, Gisbert Richard8. 1. Department of Ophthalmology, Eye Clinic, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Friedrichstrasse 18, 35392, Giessen, Germany. Lyubomyr.Lytvynchuk@augen.med.uni-giessen.de. 2. Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, 1030, Vienna, Austria. Lyubomyr.Lytvynchuk@augen.med.uni-giessen.de. 3. Center of Clinical Ophthalmology, Peremogy Ave. 42, Kyiv, 03057, Ukraine. 4. Augenärzte Kammanneye, Bahnhofstrasse 3, 7270, Davos, Switzerland. 5. Department of Ophthalmology, Eye Clinic, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Friedrichstrasse 18, 35392, Giessen, Germany. 6. Department of Ophthalmology, University of Warmia and Mazury, Zolnierska 18, 10-561, Olsztyn, Poland. 7. Institute for Research in Ophthalmology, Mickiewicza 24/3B, 60-836, Poznan, Poland. 8. Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
Abstract
INTRODUCTION: The choice of surgical treatment for chronic, persistent and large full-thickness macular holes (FTMH) continues to be undefined and challenging, as some of these cases remain refractory to the treatment. We report the efficacy of combination of inverted internal limiting membrane flap technique (IILMFT) and subretinal application of the fluid (SR fluid application) technique for treatment of refractory FTMHs. METHODS: Nine patients (nine eyes) were enrolled into this retrospective non-randomized exploratory consecutive case series study. All patients were diagnosed with chronic, persistent or large FTMH and were treated with a combination of IILMFT and SR fluid application technique. The following outcome parameters were analysed during 1- and 6-month follow-up visits: anatomical FTMH closure rate on spectral domain optical coherence tomography (SD-OCT), best-corrected visual acuity (BCVA), degree of postoperative retinal displacement. RESULTS: The mean preoperative diameter of FTMH was 542.0 μm (range 154-1930 μm). Final closure of FTMH was achieved in nine of nine cases (100%). In one case a second operation was required because of postoperative rhegmatogenous retinal detachment. The mean BCVA after the FTMH closure increased from 1.0 logMAR (0.7-1.3) to 0.4 logMAR (0.2-0.8 logMAR) (W = 2.67; p = 0.008). A positive correlation was revealed between preoperative BCVA and axial length (ρ = 0.67, p = 0.048), between preoperative BCVA and duration of the symptoms (ρ = 0.818, p = 0.007), as well as between postoperative BCVA at 1-month follow-up and BCVA at 6-month follow-up (ρ = 0.821, p = 0.007). CONCLUSION: Combination of IILMFT with SR fluid application technique for refractory FTMH surgery appears to be effective and safe. Improvement of anatomical and visual outcomes after the single surgery benefits from and is ensured by the advantages of both novel surgical approaches.
INTRODUCTION: The choice of surgical treatment for chronic, persistent and large full-thickness macular holes (FTMH) continues to be undefined and challenging, as some of these cases remain refractory to the treatment. We report the efficacy of combination of inverted internal limiting membrane flap technique (IILMFT) and subretinal application of the fluid (SR fluid application) technique for treatment of refractory FTMHs. METHODS: Nine patients (nine eyes) were enrolled into this retrospective non-randomized exploratory consecutive case series study. All patients were diagnosed with chronic, persistent or large FTMH and were treated with a combination of IILMFT and SR fluid application technique. The following outcome parameters were analysed during 1- and 6-month follow-up visits: anatomical FTMH closure rate on spectral domain optical coherence tomography (SD-OCT), best-corrected visual acuity (BCVA), degree of postoperative retinal displacement. RESULTS: The mean preoperative diameter of FTMH was 542.0 μm (range 154-1930 μm). Final closure of FTMH was achieved in nine of nine cases (100%). In one case a second operation was required because of postoperative rhegmatogenous retinal detachment. The mean BCVA after the FTMH closure increased from 1.0 logMAR (0.7-1.3) to 0.4 logMAR (0.2-0.8 logMAR) (W = 2.67; p = 0.008). A positive correlation was revealed between preoperative BCVA and axial length (ρ = 0.67, p = 0.048), between preoperative BCVA and duration of the symptoms (ρ = 0.818, p = 0.007), as well as between postoperative BCVA at 1-month follow-up and BCVA at 6-month follow-up (ρ = 0.821, p = 0.007). CONCLUSION: Combination of IILMFT with SR fluid application technique for refractory FTMH surgery appears to be effective and safe. Improvement of anatomical and visual outcomes after the single surgery benefits from and is ensured by the advantages of both novel surgical approaches.
Entities:
Keywords:
Hydraulic centripetal macular displacement technique; Inverted ILM flap; Macular hole closure; Pars plana vitrectomy; Persistent macular hole; Retinal adhesion; Subretinal fluid application
Authors: Steve Charles; John C Randolph; Aneesh Neekhra; Charles D Salisbury; Nathan Littlejohn; Jorge I Calzada Journal: Ophthalmic Surg Lasers Imaging Retina Date: 2013 Jan-Feb Impact factor: 1.300